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Contemporary reactions to smallpox inoculation in eighteenth-century France Davis, Charles Michael 1979

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CONTEMPORARY REACTIONS TO SMALLPOX INOCULATION IN EIGHTEENTH-CENTURY FRANCE by CHARLES MICHAEL DAVIS B.A. , Ohio S t a t e U n i v e r s i t y , 1976 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS In. THE FACULTY OF GRADUATE STUDIES Department of History We a c c e p t t h i s t h e s i s as conforming to the r e q u i r e d s t a n d a r d THE UNIVERSITY OF BRITISH COLUMBIA A p r i l , 1979 (c) C h a r l e s M i c h a e l D a v i s , 1979 I n p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f t h e r e q u i r e m e n t s f o r an a d v a n c e d d e g r e e a t t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a , I a g r e e t h a t t h e L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e a n d s t u d y . I f u r t h e r a g r e e t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g o f t h i s t h e s i s f o r s c h o l a r l y p u r p o s e s may be g r a n t e d by t h e Head o f my D e p a r t m e n t o r by h i s r e p r e s e n t a t i v e s . I t i s u n d e r s t o o d t h a t c o p y i n g o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l n o t be a l l o w e d w i t h o u t my w r i t t e n p e r m i s s i o n . D e p a r t m e n t o f HlSTOftV  The U n i v e r s i t y o f B r i t i s h C o l u m b i a 2075 w e s b r o o k P l a c e V a n c o u v e r , C a n a d a V6T 1W5 D a t e J W ^ j a i l A B S T R A C T The purpose of t h i s study i s to examine the medical, r e l i g i o u s , and s o c i a l reactions to smallpox ino-culation i n French society and to analyze the nature of the controversy and the dominant part played i n i t by the learned community and medical profession of France as i t took shape i n the general context of the eighteenth century. The approach has stressed those aspects of the s o c i a l history of medical ideas and practices and of the s o c i a l history of contemporary thought which seems to make sense of the important discussions over inoculation. Although s t r i c t l y speaking the controversy over inoculation did not cease at any point i n the eighteenth century, the most important discussions took place between 1714 and 1775. Therefore, the present study w i l l not deal with events a f t e r 1775 during which time the practice of inoculation became accepted, though not un i v e r s a l l y esta-blished, i n France. I t i s important to note the period under discussion marked a c r u c i a l phase i n the history of the Enlightenment i n France, for the campaign on behalf of inoculation then assumed many of i t s special c h a r a c t e r i s t i c s . Certain key developments occurred which provide the framework of t h i s study. The f i r s t i s concerned with the safety of the methods and development i n their techniques during the course of the eighteenth century which helps to ex-pl a i n the motives and timing for the general acceptance of smallpox inoculation. The second deals with the s o c i a l , r e l i g i o u s , and medical responses to inoculation i n the early eighteenth century. The fear that p a r t i a l ino-culations of only some members of the community would spread the natural form of the disease to the rest was the p r i n c i p a l reason which accounts for the pr o h i b i t i o n of the practice during t h i s period. The t h i r d deals with three of the most important aspects of the controversy. F i r s t l y , :•.'.> the growing i n t e r e s t of "enlightened" governmental autho-r i t i e s and medical men to extend the practice to the suffering masses as well as the i n t e r r e l a t e d measures of public health and hygiene; secondly, the tendency to abandon t r a d i t i o n a l r e l i g i o u s and medical values and to substitute for them a new way of thinking based on pro-b a b i l i s t i c formulations of comparative mortality rates of inoculated and natural smallpox cases; and t h i r d l y , the re-l a t i v e l y high price of inoculation and the reluctance of medical personnel to spread inoculation to the French population as a whole. TABLE OF CONTENTS page ABSTRACT i i TABLE OF CONTENTS i v ACKNOWLEDGEMENT V I. INTRODUCTION . . 1 Notes . . . .... 26 I I . THE TECHNIQUES OF INOCULATION .. 34 Notes 51 I I I . RESISTANCE TO THE INTRODUCTION OF INO-CULATION AGAINST SMALLPOX 56 Notes 74 IV. THE EARLY PRACTICE OF INOCULATION AND ISSUES IN ITS SLOW GROWTH 78 Notes .... 117 CONCLUSION . .... 128 SELECTED BIBLIOGRAPHY 132 - i v -ACKNOWLEDGEMENT I would l i k e to thank Professor Harvey M i t c h e l l for encouraging the study of French s o c i a l history and for supervising the thesis. I would also l i k e to ex-press my gratitude to Louise May for the stimulating discussions about the relationship between medicine and society, and to Barbara Gibson, the BioMedical L i b r a r i a n , for sharing with me her vast knowledge of medical history. The substantial task of typing the thesis was undertaken, between other duties, by Carmen de S i l v a , who,unlike my-s e l f , remained calm and e f f i c i e n t even i n the f i n a l , hectic stages. And, above a l l , I would l i k e to express special thanks to my parents and Wendy, for encouraging me when I was beginning to f l a g . This thesis i s offered, i n part compensation, to them. -v-1. INTRODUCTION The purpose of t h i s study i s to examine the medical, r e l i g i o u s , and s o c i a l responses to smallpox inoculation i n French society and to analyze the nature of the con-troversy and the dominant part played i n i t by the learned community and medical profession of France as i t took shape i n the general context of the eighteenth century. Although s t r i c t l y speaking the controversy over inoculation did not cease at any point i n the eighteenth century, the most important discussions took place between 1714 and 1775. Therefore, the present study w i l l not deal with events a f t e r 1775 during which time the practice of inoculation became accepted, though not universally established, i n France. I In recent years, the h i s t o r i a n of early modern Europe has become increasingly fascinated with medicine and disease. Although defined i n various ways, the history of medicine and disease .is- distinguished from other f i e l d s of s p e c i a l i z a t i o n by .its::- concern with health-related pro-blems and recently with describing the complex rela t i o n s h i p between disease patterns, socioeconomic structure and en-vironmental conditions.''" To a considerable extent, the goal i s to redress the imbalance i n medical hi s t o r y which has been t r a d i t i o n a l l y l i m i t e d to studies which i n general emphasize the in t e r n a l development of medicine. The demographer attempts to employ quantitative research techniques with the goal of avoiding generalizations that rest on impressionistic evidence, and i s receptive -at least i n theory - to the systematic testing of broad conceptual hypotheses developed i n the s o c i a l and be-havioral sciences. A growing number of demographic-re-lated works have focused on inf e c t i o u s diseases such as typhoid, tuberculosis and smallpox, as well as a vaguer group of chronic infections - grippe, dysentery and pneumonia - which appeared sporadically and p e r i o d i c a l l y throughout Europe between the seventeenth and nineteenth cenutries. In fact, these infectious diseases were"capable of a f f e c t i n g the size and structure of the population and ' were so devastating that they are now considered as press-ing a topic as the experiences of the plague between the 2 fourteenth and sixteenth centuries. Hence, the demographer hope i s to illuminate the histroy of population changes of a given society by means of explaining the ways i n which 3 mortality and morbidity patterns changed over time. The s o c i a l h i s t o r i a n , on the other hand, i s distinguished by his concern with describing the precise nature of socioeconomic structures as well as the complex relationship between disease patterns and environmental 3. conditions. Hence, the goal of t h i s new f i e l d of s o c i a l h i s t o r y i s two-fold: f i r s t l y , to break down t r a d i t i o n a l d i s c i p l i n a r y d i s t i n c t i o n s ; and secondly, to create a new and u n i f i e d way of understanding the t o t a l i t y of human 4 a c t i v i t y within a given society or geographical region. By adopting a m u l t i d i s c i p l i n a r y approach, the s o c i a l h i s t o r i a l can now concentrate on such key issues as the changing incidence of disease, i t s impact upon society, the manner i n which people respond to health-related problems, and the ways i n which morbidity and mortality patterns are related to environmental, n u t r i t i o n a l , 5 economic, technological, and medical factors. There i s every reason to believe, therefore, that s o c i a l h istorians w i l l increasingly turn t h e i r attention to health-related problems i n much the same way they began to examine the relationship between ideology and s o c i a l structure, c h i l d -hood experiences, family history, and morbidity patterns. I t i s clear that the extensive and important body of the more t r a d i t i o n a l history of medicine stressed the assumptions and objectives of medical men, t h e i r approaches to disease, t h e i r methods and the progressive development of p a r t i c u l a r patterns of thought i n the treatment of disease. To a large extent, the i n t e r n a l history of medicine leads to an emphasis on the role of key in d i v i d u a l s , or the evolution of b e l i e f s and ideas regarding given disease e n t i t i e s . In t h i s sense, the goal i s to explain how c e r t a i n concepts and ideas developed and how they changed over time. 4 . For our purposes, i t i s necessary to provide a general discussion of medical thought and theories of disease to i l l u s t r a t e the strengths that arise out of adequate knowledge of the i n t e r n a l history of medicine as distinguished from the external factors that influenced the medical profession. By the late eighteenth century, medicine was influenced by the p r e v a i l i n g emphasis on a c l a s s i f i c a t i o n of diseases which could be derived from 7 the c o l l e c t i o n and analysis of p a r t i c u l a r f a c t s . The underlying assumption was that diseases had a natural and independent existence apart from the subjective perceptions of the human observer. Hence, the goal of nosological medicine was two-fold: f i r s t l y , to give unambigious de-f i n i t i o n s of diseases; and secondly, to show the r e l a t i o n -ships and inner nature of disease states with s i m i l a r g c h a r a c t e r i s t i c s . Doctors developed a nosology based on external symptoms and defined pathological states by describing them i n terms of external and v i s i b l e symptoms. This process was i n e v i t a b l e , because neither technology nor theory could e s t a b l i s h a relationship between bio-9 l o g i c a l mechanisms and external symptoms. In fact, a c l a s s i f i c a t i o n system based on external symptoms created serious i n t e l l e c t u a l and " s c i e n t i f i c " problems. Was fever, for instance, one disease state or many? While often disagreeing on s p e c i f i c s , few doctors questioned the practice of defining disease by observing symptoms. At the time no other alternative was a v a i l a b l e . 5 . Although i t i s to some extent true that t h i s approach may have, at least from the viewpoint of the new s o c i a l history, c e r t a i n shortcomings, i t also possesses cert a i n strengths, an understanding of which i s indispensable for further work. Hence, any serious work on the s o c i a l dimensions of medicine and disease must begin with a firm understanding of the evolution of a medical theory, i f only because primary sources r e f l e c t a p a r t i c u l a r genera-tion's understanding of pathological processes. The t r a d i t i o n a l stress on the i n t e r n a l development of medicine and disease has recently been widened i n scope and range to deal with the rel a t i o n s h i p between states of health and society. The s i g n i f i c a n t studies, as we s h a l l see, have attempted to analyze such themes as morbidity and mortality patterns i n r e l a t i o n to environmental, n u t r i t i o n a l and economic conditions, popular attitudes toward i l l n e s s and disease, the o r i g i n s of public health, and the emergence of government and medical i n t e r v e n t i o n i s t p o l i c i e s which sought to minimize the pathological pro-cesses. S p e c i a l i s t s i n t h i s f i e l d have an o b l i g a t i o n to study the interplay between external and i n t e r n a l factors in writing about the history of medicine and disease. Since the s o c i a l h i s t o r i a n has become preoccupied with the role of population growth, environmental con-ditions and socioeconomic structure i n t h e i r r e l a t i o n s h i p to infectious diseases, he has developed a sophisticated understanding of some of the underlying issues. One such 6. important book i s Medecins, climat et epidemies a l a f i n du XVTII e s i e c l e edited by J.P. Desaive with contributions by a team of French scholars whose e a r l i e r demographic, clima t o l o g i c a l and other related writing are well known. The major contribution to the volume i s the j o i n t chapter by Emmanuel Le Roy Ladurie and Desaive. I t rests on the records of the medical and meteorological sciences of the late eighteenth century, providing a systematic analysis of each French region, with the most sophisticated computer program techniques available."'"''" Moreover, they point out several other important areas of research. They t e l l us something, for example, about the seasonal fluctuations and sequence of harvests during the period under discussion. The account here corresponds i n several d e t a i l s with what Ernest Labrousse, Michel Morineau and 12 others have noted on the price cycles of the time. Short-term meteorological evidence may o f f e r clues to the grouping of harvests i n periods of good and bad years. The relevant data, however, are c e r t a i n l y far too disparate and imprecise to allow more than tentative conclusions. They have generalized cautiously from c e r t a i n weather stations whose records are r e l a t i v e l y d e t a i l e d . They have claimed that cold, wet summers brought poorer harvests, l i k e the ones of 1783-4, 1784-5, and 1788-9, which may 13 help to explain why the Revolution came when i t did. Indeed th i s evidence merits serious consideration. The question which remains, however, i s whether or not the 7. sources do i n fact t e l l us something about the complex r e l a t i o n between good and bad crop years, socioeconomic, c u l t u r a l and demographic factors, and disease patterns. The studies by Jean Meyer and J.P. Goubert give s o l i d evidence to help explain why Brittany did not conform to the national norm of r e l a t i v e l y rapid population growth i n the late eighteenth century. In the period from 1770-84, while i t i s generally agreed, that the French population as a whole increased by almost 6 per cent (excluding 14 migrations), that of Brittany decreased by 3.7 per cent. Other figures show a decrease of 4.5 per cent over the 15 period 1770-87. According to both studies, i t i s clear that the frequent recurrence of epidemics such as typhoid, dysentery and smallpox were a major cause of the "demo-graphic c r i s e s " there. Meyer and Goubert have also pointed out that the problem of epidemics was worsened by widespread popular indifference towards even elementary hygiene. Besides contact with infected people and contaminated water supplies, the two most common ways i n which contagion spread, germs were often transmitted from animal husbandry to human beings, for instance, through t h e i r waste. More sanitary forms of sickbed v i g i l s and b u r i a l were slow to 16 come. In addition, the potato was considered to be an i n f e r i o r foodstuff to buckwheat (sarrasin) as well as a number of cereal compounds whose n u t r i t i o n a l value was li m i t e d but which formed the basis of the r u r a l popular 8. d i e t . This may be the most important single reason for the epidemics which a f f l i c t e d the Brittany populace re-l e n t l e s s l y - i n 1739-41, 1747-49, 1758, 1764-65, 1770-75, 17 1779, 1782-83, 1786 and 1788 ". The widespread under-nourishment of the r u r a l populace meant that resistance was r e l a t i v e l y low at the best of times which undoubtedly contributed to population decline i n c e r t a i n regions. When c r i s i s struck, the f i r s t to succumb were usually young children, the aged, and the f r a i l . A l l of these combined to increase the incidence of diseases that de-vastated the population. J.P. Peter's a r t i c l e was p r i n c i p a l l y directed towards the study of diseases, though the l a t t e r section focused on the role of environmental factors i n r e l a t i o n to disease i n r u r a l society. The medical analysis, however, has some speculative points on the subject of p s y c h i a t r i c d e f i n i t i o n s of disease. For example, Peter stated: A frightening encounter with disease, personal troubles, fear - a l l of these often evoked responses of the same type, namely, convulsions and even p a r a l y s i s . These reactions had strong h y s t e r i c a l overtones. In our time these reactions are d i f f e r e n t . They are more apt to be depressive or schizoid; although the s o c i o l o g i c a l phenomena connected with rock n ' r o l l seems to indicate a return to the f i r s t responses of the former type: c o l l e c t i v e h y s t e r i a . This i s the f i r s t sign of a mutation brought about by our mass society.18 This explanation i s too present-minded. I f physiological processes are responsible for emotional disturbances, we 9. cannot i d e n t i f y them. Nor i s i t possible at present to specify the role played by either genetic or environmental factors i n producing what i s designated as a mental disease. Yet, i n dealing with the relationship between health and environment, Peter has demonstrated an understanding of some of the central issues. For example, he has focused on the role of environmental factors i n r e l a t i o n to l i v i n g patterns. In this connection, Peter has pointed out the construction of crude dwellings without adequate v e n t i l a t i o n or l i g h t i n g ; the lack of intensive c u l t i v a t i o n which brought about drainage problems; the large pools of stagnant water i n a community; the l i k e l i h o o d of epizootic diseases; and the high l e v e l of malnutrition which pro-bably decreased resistance to diseases such as typhoid and smallpox. A l l of these factors combined no doubt to i n -19 crease the incidence of disease throughout r u r a l France. The evidence supplied by Desaive and his contributors was not alone i n stressing the mutual interdependence of disease patterns, environmental conditions and socio-economic structures . In Les Hommes et Les morts en Anjou  aux 17 e et 18 e s i e c l e s , Francois Lebrun traced the i n t e r -r e l a t i o n between s o c i a l and r e l i g i o u s values on the one hand and attitudes toward i l l n e s s , health, disease and death on the other. Moreover, he argued that Anjou, l i k e other west coast provinces, was economically "backward", and did not encounter an increase i n population due to 10. recurrent famines and epidemics i n the late eighteenth century. In his detailed analysis of the causes of death, Lebrun, too, established very c l e a r l y the dominant part 20 played by malnutrition and poor hygiene. I f doctors had some success i n dealing with epidemics towards the end of the period, i t was because they too saw these basic f a c t s . Their treatment consisted to some extent 21 of keeping the suffering masses clean and adequately fed. Lebrun also showed how the appearance of an epidemic would destroy even family bonds, and allow the victims to be 22 buried i n mass graves i n unhallowed ground. In fact, the population as a whole seems to have cared more about r e l i g i o n than medical attention at the moment of death. This was part of an extremely t r a d i t i o n a l i s t mentality which preferred the remedies of the l o c a l "empiric" to the 23 " r a t i o n a l " prescriptions of the doctor. S i m i l a r l y , J.P. Goubert i n a recent work showed how the prevalence of epidemic and chronic diseases was a re-s u l t of environmental and c u l t u r a l patterns, and how the Breton population's response to disease was conditioned by t h e i r socioeconomic structure Another important health-related problem which we have only touched upon i s the possible consequence of i l l n e s s , namely, death. This i s not to suggest that every disease,leads to death, however, i n l i g h t of the inadequate medical cures, the loss of health was considered the f i r s t 11. step to death i n the eighteenth- century. In the in t e r e s t i n g study Western Attitudes toward Death from the Middle Ages to the Present, Philippe Aries has suggested that the omnipresence of death from the Middle Ages u n t i l the end of the eighteenth century produced a " f a m i l i a r i t y with death," "a coexistence of the l i v i n g and the dead," even a "promiscuity between the l i v i n g and the dead." This, i n turn, led Aries to speak 2 6 about a "tamed death" i n regard to that era. I t may be assumed that the prevalence of i l l n e s s •- the high infant mortality, the mortality of mothers in c h i l d b r i t h , the mortality of people succumbing to epidemics i n t h e i r prime -led to a f a m i l i a r i t y with a l l forms of i l l health. The certainty of death and the f r a i l i t y of l i f e were at the time quite obvious and commonplace. The suffering masses never thought of escaping or g l o r i f y i n g them. I f they were able to int e r p r e t death as a kind of acceptance of the laws 27 of nature, th i s concept with respect to i l l n e s s was probably not i n the forefront. Certainly'we would not go as far as Jacques Dupaquier, who speaks i n t h i s context 2 8 of a kind of b i o l o g i c a l l y t e r r o r i z e d population. Even i f the h i s t o r i a n no longer interprets i l l n e s s i n terms of theology/ one must constantly make an e f f o r t to confront i l l n e s s through the eye's of the people who are being studied. For example, Lebrun 1s view of the seventeenth and eighteenth centuries' experience of suffering and 12 i l l n e s s as a mystery i s very p l a u s i b l e . Illnesses were w i l l e d by God. They represented either i n d i v i d u a l l y , or i n the case of epidemics., c o l l e c t i v e punishments for sins committed, or else they represented a warning to make proper preparations for death. The i l l n e s s of the body was supposed to help the recovery of the soul. U n t i l the mid-eighteenth century when a doctor was consulted, his job was more the ministration of the patient's soul than of his body."^ As long as i l l n e s s was considered an expression of supernatural forces, f a i t h and superstition were c l o s e l y ;. related. There was only one step from the notion of divine intervention to the idea of the intervention of the d e v i l s or demons of disease, from the appeal to the 31 Church to reliance on magic, "empirics" and quacks. Moreover, as long as disease had a magical-supernatural character and l i t t l e " s c i e n t i f i c " i n t e r e s t i n seeking the natural cause of i l l n e s s , there was no reason to be treated by a " r a t i o n a l " doctor or surgeon who t r i e d to o f f e r exact 32 and comprehensible i n s t r u c t i o n s . The h i s t o r i a n of medicine and disease should also turn his attention to an analysis of health care i n s t i t u -tions. The hospitals of the eighteenth century were organized to meet the needs of the aged and in f i r m without family and the suffering masses known as the "sick" poor, who, for reasons of work, depended on good health and could not avoid the hospital or s i m i l a r charitable organizations. In his important book Medicine at the Paris .Hospital 1794-1848, Erwin H. Ackerknecht described the trans-formation of the doctor/"sick-man" r e l a t i o n s h i p . According to .Ackerknecht, i n a functioning h o s p i t a l , the doctor presided over the course of recovery i n an. authoritarian 34 manner. Moreover, Ackerknecht pointed out the de-velopments of in t e r n a l medicine such as nosology, l o c a l i z e d pathology, physical examination and s t a t i s t i c a l analysis to i l l u s t r a t e the dramatic s t r u c t u r a l change of the h o s p i t a l . S i m i l a r l y , Michel Foucault analyzed such themes as the emergence of a new role for the "sick-man", that of patient, the new occupational p o s i t i o n of the c l i n i c i a n and the 35 major achievements during the late eighteenth century. N.D. Jewson helps to explain how the t r a n s i t i o n from "bed-side medicine" to "hospital medicine," and the tolerance of authoritarianism was based on a new kind of r e l a t i o n between the "sick-man" and the medical p r a c t i t i o n e r which represented the f i r s t major steps towards the i n s t i t u t i o n a l i z a t i o n of 36 the "sick-man" as an object of study by c l i n i c i a n s . Although the i n s t i t u t i o n and i t s s t a f f , the changing practice of medicine, s t r u c t u r a l d i f f e r e n t i a t i o n and modes of support are by no means of h i s t o r i c a l i n s i g n i f i c a n c e ; the most c r u c i a l element, namely, the c l i e n t e l e s t i l l requires further work. Cl e a r l y , there i s much to be learned by studying patients as well as medical p r a c t i - : tioners. By using patient records (where they are a v a i l -able) , the h i s t o r i a n may then be i n a po s i t i o n to raise important questions about the ways i n which groups perceived doctors and hospitals., the changing incidence 37 of disease, and d i f f e r e n t i a l care and treatment. So far our discussion has tended to focus on certa i n problems and prospects of research i n the historiography of medicine and disease i n eighteenth-century France. To a considerable extent, the foregoing discussion has dealt with the s o c i o - h i s t o r i c a l approach to key health-related issues such as the changing incidence of disease in- various regions of France, the major epidemic and chronic diseases that affected t h e i r people, t h e i r attitudes toward disease, i l l n e s s and death, and socioeconomic structures. D i r e c t l y or i n d i r e c t l y , these issues are cl o s e l y related to the following health-related problem: namely, the keen and protracted controversy over smallpox inoculation which occurred, i n France during the eighteenth century. Within the past twenty years or so, smallpox i n -oculation i n the eighteenth century has attracted some attention, but seldom has i t s study been analyzed i n an acceptable s o c i o - h i s t o r i c a l fashion. Most of the s i g n i f i c a n t studies, as we s h a l l see, have eithe r a medical-or demographic-related b i a s . The t r a d i t i o n a l l i t e r a t u r e has been preoccupied with the i n t e r n a l development of medicine. To a large extent, the emphasis has been placed on the role of leading doctors, t h e i r ideas about disease and the ways i n which they perceived the proper treatment of smallpox. On the other hand, the more recent work has tended to focus on population growth with i t s r e l a t i o n to the changing incidence of smallpox. Yet, the h i s t o r i a n writing about inoculation has shown l i t t l e i n t e r e s t i n undertaking studies of population changes which relate the p e r i o d i c i t y of smallpox to environmental, n u t r i t i o n a l , economic, technological and medical factors. So far the approaches to the topic have admittedly contained short-comings. They have confined the historiography of i n -oculation within narrow boundaries and have made i t a subject for impressionistic or s t a t i s t i c a l study. Within the past two decades, a number of works have focused on the medical and demographic approach to the h i s t o r i c a l l i t e r a t u r e . The f i r s t important study was Genevieve M i l l e r ' s The Adoption of Inoculation for Small-pox i n England and France (1957). In her introduction, M i l l e r j u s t i f i e d her e f f o r t s by drawing attention to the fact that "the history of inoculation was written c h i e f l y by physicians, and only b r i e f references occurred i n general 3 8 h i s t o r i c a l l i t e r a t u r e . " Therefore, M i l l e r attempted to integrate the e a r l i e r medical l i t e r a t u r e within the frame-work of an i n t e l l e c t u a l - h i s t o r i c a l approach to explain how the "non-medical ' s c i e n t i s t s ' " - at l e a s t i n England -played a dominant r o l e i n the permanent acceptance of t h i s prophylactic measure against smallpox by the mid-eighteenth century. 16. And yet, the section of the book which deals with the internal developments in France has certain short-comings. F i r s t l y , though the general conclusions are sound, the account i s often incomplete and the facts i n -accurate, Miller besides has only a superficial under-standing of the source material's language and rationale. For instance, she argues that, "Fear of smallpox was the principal motivating force for inoculation both for i t s introduction and for i t s continuance as a valid medical 39 procedure." To some extent, Miller's viewpoint merits serious, consideration, but only in the case of England. At no time in France during the eighteenth century did the element of fear lead to the universal acceptance of the practice. In fact, the fear of inoculation infecting healthy people with material taken from a patient with smallpox, the belief in secondary contagion as a result of inoculation, and the reluctance to accept inoculation because i t did not necessarily lessen the risk of natural smallpox, a l l played a significant part in the prohibition of the practice. Secondly, the discussion of the nature of the con-troversy and the role played in i t by the learned community and medical profession of France principally relates to the logic and theory of medical ideas such as the classical humoral theory set forth by the Arabic doctor Rhazes and 40 his disciples and largely neglects a religious, p o l i t i c a l , economic and cultural analysis for a full e r understanding of the complex problem. In addition, her treatment of the subject serves as a study to compare the "advanced thinking" of the English medical community on inoculation with the "backward" thought i n France. More importantly, she i s not f a m i l i a r with such key questions as the growing concern of learned men and medical p r a c t i t i o n e r s over issues focusing on the "public good", hygienic practices, and a safer method of inoculation which are central to an understanding of the motives and timing for the acceptance of the p r a c t i c e . In the 1960s the emphasis began to s h i f t towards the study of disease incidence which were explored by P.E. 41 Razzell. Using the techniques of h i s t o r i c a l demography, Razzell concentrated on the decline of smallpox death t o l l as a r e s u l t of inoculation to show how c l o s e l y related t h i s practice was to the transformations England ex-perienced i n both population growth and the i n t e n s i f i c a -t i o n of i n d u s t r i a l production during the eighteenth century. Razzell's i n t e r e s t i n g a r t i c l e , however, f a i l s to explain how the contribution of medical influences and im-provements i n public health account for the population growth i n England as a whole. A decline i n deaths follow a discernible pattern: r i s i n g standards of l i v i n g , f i r s t i n food supplies, removal of s p e c i f i c hazards i n physical environment, and s p e c i f i c measures of preventing and treat ing disease of the i n d i v i d u a l . Hence, i t seems unlikely 18 . that the growth of population, could be due to a fortuitous decline of mortality from smallpox, an explanation offered by the economic h i s t o r i a n i n somewhat disguised", form by reference to the plague. If these p o s s i b i l i t i e s are ex-cluded, the growth of population must have been due to an improvement i n l i v i n g conditions, whether t h i s led primarily to a r i s e i n the b i r t h rate or a decline of mortality. P.E. Razzell's l a t e s t work, The Conquest of Smallpox (1977), i s another demographic approach to assess the de-';V c l i n e of mortality due to inoculation i n mid-eighteenth century England and i n the r e l a t i o n s h i p between population growth and the I n d u s t r i a l Revolution. In so doing, Razzell has argued that, "Smallpox ranks with bubonic plague i n i t s h i s t o r i c a l importance, and without i t s gradual elimination, the world's population would have suffered the kind of decimation r e s u l t i n g from the Black Death, and the In-d u s t r i a l Revolution of the late eighteenth and early nine-42 teenth century would not have been possible." This i n -terpretation has been questioned by two recent a r t i c l e s that focus on the smallpox mortality rates i n Geneva and Finland during the period under discussion. These de-mographers have made a case for the n e g l i g i b l e e f f e c t of inoculation on the reduction of smallpox mortality and have stressed that neither inoculation nor vaccination convincingly explains why the population of Europe began to increase rapidly i n the late eighteenth century and 43 to continue i t s upward movement i n the nineteenth century. The growth of population i n England as suggested i n Razzell's studies implies that a s i g n i f i c a n t improvement i n health began much e a r l i e r - at le a s t seventy years before the 183 8 national r e g i s t r a t i o n of b i r t h s , deaths 44 and causes of deaths. Hence, the growth of population cannot be attributed to s p e c i f i c medical measures such as deliberate immunization and therapy which can hardly have been more e f f e c t i v e i n the eighteenth century than the 45 nineteenth. In a period of malnutrition, a r e l a t i v e l y low standard of l i v i n g , and l i m i t e d advancement i n health standards, i t seems un l i k e l y that the practice of inocula-tion led to a reduction of mortality from smallpox to 46 account for the increase of population. Marc Barblan has focused, i n a cursory manner, on the extent of the practice of inoculation and vaccination i n a regional context during the late eighteenth and early 47 . nineteenth centuries. In the case of inoculation, Barbl has stated: II semble bien que, jusqu'a 1'introduction de l a vaccination, les inocules - par rapport a 1' ensemble de l a population, ou aux naissances-ne representent que quelques cas i s o l e s qui ont d'autant plus frappe 1'imagination des memorialistes ... q u ' i l s ' a g i s s a i t de magistrats ou de l a famille royale, tout au moins de membres de l a "upper cla s s . " Limitee socialement a l'e'lite e'claire'e ou a une f r a c t i o n de c e l l e - c i , 1'inoculation a egalement ete limitee geographiquement.48 20. Unfortunately, Barblan's conclusions are i n doubt on several points. F i r s t l y , he does not f u l l y e x p l o i t the s t a t i s t i c a l evidence to c l e a r l y i l l u s t r a t e the p e r i o d i c i t y of smallpox epidemics, the age incidence and the o v e r a l l e f f e c t s of inoculation and vaccination i n terms of reduced smallpox death t o l l s ; and secondly, he does not f u l l y de-velop the popular opposition to inoculation i n order to show the lim i t e d extent of the practice during the period under discussion. U n t i l such studies have advanced to the point where th e i r main conclusions are not i n doubt, there w i l l remain a serious deficiency i n the history of medicine and disease. On the basis of the foregoing analysis, there seems to be some merit i n reinterpreting the controversy over i n -oculation i n eighteenth-century France. But why i s i t that the French medical profession and learned community seized upon the practice of inoculation i n the eighteenth century? To thi s question, I w i l l suggest several tentative answers. F i r s t l y , contemporaries during t h i s period were unanimous that, "Tous l e s hommes, ' 4 9 sans exception, sont sujets a l a pe t i t e verole." Charles-Marie de La Condamine, the celebrated geographer and mathematician, summed up contemporary opinion on the prevalence of smallpox: Une maladie affreuse and c r u e l l e , dont nous portons le germe^dans notre sang, d e t r u i t , mutile ou defigure un quart du genre humain. Fleau de l'ancien monde, e l l e a plus deyaste le nouveau que 21. le f e r de ses conquerans: c'est un instrument de mort qui frappe sans d i s t i n c t i o n d'age, de sexe, de rang ni de climat. Peu de families £chappent au t r i b u t f a t a l qu'elle exige. C'est sur-tout dans les v i l l e s and dans les cours les plus b r i l l a n t e s , qu'on^la v o i t exercer ses ravages. Plus les tetes qu'elle menace sont elevees ou precieuses, plus i l semble que les armes qu'elle emploie sont redoutables: on v o i t assez que je parle de l a petite verole.^0 Unfortunately, s t a t i s t i c a l evidence on smallpox mortality rates between 1714 and 1775 i s unavailable. Therefore, the present study i s unable to determine the u n i v e r s a l i t y of the disease, the age incidence and the p e r i o d i c i t y of small-pox . Another factor was i n the i n s t i t u t i o n a l organization of the Academie des Sciences which during the course of the eighteenth century was recognized as the most powerful and professional " s c i e n t i f i c " i n s t i t u t i o n i n Europe. Unlike the Royal Society i n England, incorporated by royal charter but organized as a private society, the Academie des Sciences had been developed as an i n s t i t u t i o n of the state with the " s c i e n t i f i c " and technical needs of the state c l e a r l y and d i r e c t l y i n mind.^ "*" Since the Academie was sometimes c a l l e d upon to investigate health-related issues of importance to the Royal Administration, learned men, i n turn, attempted to bring about the reduction of deaths from smallpox within the power of the medical profession. Therefore, the h i s t o r i c a l value of the writings on inoculation contained i n the H i s t o i r e de 1'Academie Roy ale' des Sciences derives from the size and qu a l i t y of i t s response to smallpox inoculation and i n the fact that the reactions coincided with the growing concerns of the Royal Administration. From t h i s mutual i n t e r e s t , learned men began for the f i r s t time to focus on the "national good," that i s , a healthy and productive population for the benefit of both the state and society, i n a s t a t i s t i c a l fashion. And why was La Condamine the p r i n c i p a l champion of inoculation i n France? The answer may l i e i n several approaches. F i r s t l y , he was a prominent figure i n that widespread attempt to apply and extend " s c i e n t i f i c " think-ing and new knowledge to a l l segments of society that was becoming a s a l i e n t feature of eighteenth-century France. Among the would-be Newtons of astronomy, he combined active involvement i n s o c i a l and p o l i t i c a l a f f a i r s with an i n -s t i t u t i o n a l commitment to " s c i e n t i f i c " i n v e s t i g a t i o n and a 52 growing professional acquaintance with i t s methods. In addition, La Condamine began his program for the acceptance of inoculation against smallpox at a time when more c u r i o s i t y and i n t e r e s t was being shown by learned men i n the i n t e l l e c t u a l , " s c i e n t i f i c " and l i t e r a r y developments 53 given to countries outside of France. As a r e s u l t , he came of age as the most s i g n i f i c a n t and i n f l u e n t i a l partisan of inoculation i n t h i s period of French hist o r y . Moreover, La Condamine's conception of inoculation, his view of medicine as a practice to save l i v e s , was there-fore not only an informed one. I t was also to;a considerable extent, t y p i c a l of the most advanced thought of the time. I t was i n the i n s t i t u t i o n a l context of the Academie des 54 Sciences, as i n the more general context of the p h i l o - .... ^. sophe movement, that he developed his views regarding the s o c i a l reform of medicine and i t s r e l a t i o n s h i p to the " s c i e n t i f i c " organization of society. Hence, th i s study i s divided into three main parts, one dealing with the safety of the methods and development i n i t s techniques, the second with the f r u i t l e s s attempt to introduce t h i s medical practice i n France, and the t h i r d with the keen and protracted struggle for acceptance of the practice by the learned community during the mid-eighteenth, century. Since the problem i s complex and the primary data are d e f i c i e n t , i t must be said at the outset that the attempt to provide r e l i a b l e national estimates of smallpox mortality in France, by exploiting the information available on certain key s t a t i s t i c s such as the parish r e g i s t e r s , are 55 l i k e l y to be imprecise, inaccurate and incomplete. In addition, as with a l l s t a t i s t i c s , the way i n which they are arranged and interpreted can completely a l t e r the con-clusions reached from them; most eighteenth-century writers on t h i s subject, p a r t i c u l a r l y by the mid-century, were supporters of inoculation and used the s t a t i s t i c a l i n -formation to show that smallpox mortality was reduced to a large extent through the practice of inoculation. There i s one general problem, however, i n attempting to estimate the contribution of any one disease to t o t a l mortality, and that i s the i n d i r e c t mortality which cannot be s p e c i f i c a l l y a ttributed to that disease. The approach, therefore, has been to present the controversy over inoculation i n as broad a framework as possible, r e l a t i n g aspects of the s o c i a l history of medical ideas and practices and society i n eighteenth-century France. Secondly, I have attempted to elaborate the contemporary thought on the subject by reconstructing what I i n t e r p r e t to be the main outlines of the controversy, the problems posed by medical, r e l i g i o u s and s o c i a l re-action and the i n t e l l e c t u a l tools at t h e i r disposal to answer them. For the most part, each phase of the con-troversy produced an extensive body of l i t e r a t u r e as noted i n the following learned p e r i o d i c a l s : the J e s u i t Journal  de Trevoux, the Annee L i t t e r a i r e , the Journal Encyclo-pe digue , the Mercure de France and the secular Journal des  Savants. Although these standard p e r i o d i c a l s opened t h e i r columns to review a r t i c l e s on the subject, i t must be remembered that these journals were i n e f f e c t primitive newspapers not systematic l i t e r a r y r eviews.^ But they do provide some ins i g h t into the prejudices or biases of each editor regarding the controversy. Cle a r l y , there are compelling reasons why h i s t o r i a n s , building upon the work of e a r l i e r scholars, should turn th e i r attention to the s o c i a l history of smallpox inoculation i n eighteenth-century France. Hence, the present study has i t s o r i g i n s i n the f a i l u r e of recent 25. h i s t o r i a n s to deal with the relat i o n s h i p between medicine and society, and changing patterns of thought and group perceptions of smallpox. In fa c t , s u r p r i s i n g l y l i t t l e i s known about the community reaction to smallpox inoculation or the human response to smallpox epidemics. At present, historians have only begun to systematically analyze the sources and nature of group perceptions of the disease i n eighteenth-century France. In short, the j u s t i f i c a t i o n for the present study i s contained i n two, related propositions: f i r s t l y , i t i s designed to revise the conventional i n t e r p r e t a t i o n of smallpox inoculation by focusing on the medical, r e l i g i o u s , and s o c i a l aspects of the problem; and secondly, t h i s study i s meant to contribute, i n a small way, to the so c i a l history of medicine and disease i n eighteenth-century France. NOTES For a description of how four factors "morbidity," "mortality," "socioeconomic structure," and "environmental conditions" are integrated with a group of further factors derived from a " t o t a l history," see J.P. Desaive et a l . , Me1 dec ins, climat, et epidemics a l a f i n du XVIITe s i e c l e , (Paris, 1972) . 2 On the topic of how infectious disease and the changing incidence of disease played a key r o l e i n a l t e r i n g the size and structure of the French population i n Anjou and Brittany during the late eighteenth century, see Francois Lebrun, Les Hommes et l a mort en Anjou aux 17 e et 18e s i e c l e s (Paris, 1971), J.P. Goubert, Malades- et Medecins en Bretagne  1770-1790, (Paris, 1974); Idem, "Le phenomene epidemique en Bretagne a l a f i n du XVIIie s i e c l e (1770-1787)," i n Desaive et a l . , pp.225-250. Jean Meyer, "Le personnel medical en Bretagne a l a f i n du XVIII e s i e c l e , " i b i d . , pp.171-225; For a discussion on the role of infectious disease i n connec-tion with the I n d u s t r i a l Revolution and population growth i n England, see Thomas McKeown and R.G..Brown, "Medical Evidence Related to English Population Changes i n the 18th Century," i n Population i n History D.V. Glass and D.E.C. Everseley eds. (Chicago, 1965), pp.285-307. Thomas McKeown, R.G. Brown and R.G. Record, "An Interpretation of the Modern Rise of Population i n Europe," Population Studies 26 (1972), pp.345-82; McKeown, "Medical Issues i n H i s t o r i c a l Demography," i n Modern Methods i n the History of Medicine, Edwin Clarke ed., (London, 1971), pp.57-74; Idem, The Modern Rise of Population (London, 1976); and Everseley, "Epidemiology as S o c i a l History," Forward to Charles Creighton, A History of E p i -demics i n Great B r i t a i n , 2nd ed., (London, 1965). 3 For a discussion on novel methods and research techniques of h i s t o r i c a l demography i n eighteenth-century France, see Jean Meuvret, "Les c r i s e s de subsistance et l a demographie de l a France d'Ancien Regime," Etudes d'h i s t o i r e  economique, (Paris, 1 9 7 1 ) , pp.271-278; Jacques Dupaquier, Introduction a l a demographie historique, (Paris, 1974); Y. Blayo and Louis Henry, "Donnees Demographiques sur l a Bretagne et l"Anjou," Annales De Demographie Historique ( 1 9 6 7 ) , pp.91-171; L. Behar, "Des Tables de Mortality aux XVII e et XVIII e s i e c l e s : H i s t o i r e - S i g n i f i c a t i o n , " i b i d . , (1976) , pp.173-200; Dupaquier et a l . , " V i l l e s et V i l l a g e s de l'Ancienne France,".ibid., (1968), pp.10-241; and F. Lebrun, "Les Epidemies en Haute-Bretagne a l a f i n de l'Ancien Regime (1770-1789) Presentation d'une enquetecollective," i b i d . , (1977) , pp.181-206. For a discussion of the m u l t i d i s c i p l i n a r y approach to h i s t o r i c a l problems i n early modern Europe under the rubric of s o c i a l history, see Harold Perkin, "Social History i n B r i t a i n , " Journal of So c i a l History 10(1976), pp.129-143; Michelle Perrot, "The Strengths and Weaknesses of French S o c i a l History," i b i d . , pp.166-177; Gi l b e r t Shapiro, "Prospects For A S c i e n t i f i c S o c i a l History: 1976," i b i d . , pp.196-204; and Theodore Zeldin, "Social History and Total History," i b i d . , pp.237-245 . 5 See, for example, the discussion of how medical men and governmental authorities attempted to control and eradicate c e r t a i n epidemic diseases i n r e l a t i o n to public health during the late eighteenth century i n France: Jean Meyer, "L'enquete de 1'Academie de medecine sur l e s epidemies 1774-1794," Etudes rurales: no. 34 (1969)', pp.7-69; J.P. Peter, "Les mots et les objets de l a maladie. Remarques sur les epidemies et l a medecine dans l a societe francaise de l a f i n du XVIII e s i e c l e , " : Revue historique 246 (1971), pp.13-38; Idem, "Disease and the Sick at the End of the Eighteenth Century," trans. E. Forster i n Biology of Man i n History, R. Forster and 0. Ranum eds., (Baltimore, 1975), pp.81-124; and Caroline Hannaway, "The Societe Royale de Medecine and Epidemics i n the Ancien Regime," B u l l e t i n of the History of Medicine, XLVI (1972), pp.257-73. General discussions on the theories of disease may be found i n : Lester King, The Medical World of the 18th  Century, (Chicago, 1958); Idem, "Medical Theory and Practice at the Beginning of the 18th Century," B u l l e t i n of the  History of Medicine XLVI •':( 19 7 2) , pp.1-15; Idem, The Philo-. sophy of Medicine (Cambridge, 1978); M. Bariety and C. Coury, H i s t o i r e de l a medecine (Paris, 1963) :; and W.R. LeFann, "The Lost Half Century i n English Medicine," B u l l e t i n of the History of Medicine, XLVI (1972), pp.319-49. 7 On the significance of eighteenth-century nosological medicine or redescriptions of i l l n e s s i n France, see M. Foucault, The B i r t h of the C l i n i c , trans. A.M. Sheridan Smith,(New York, 1973), chapters 1-7; J.P. Peter's a r t i c l e s i n Revue histor i q u e , pp.13-38; and i n Forster and Ranum Eds., pp.81-124; Erwin H. Ackerknecht, Medicine at the Paris Hospital 1794-1848, (Baltimore, 1967), chapter 1; N.D. Jewson, "The Disappearance of the Sick-Man from Medical Cosmology, 1770-1870," Sociology X (1976), pp. 221-44; and Karl F i g l i o , "The Historiography of S c i e n t i f i c Medicine: An I n v i t a t i o n to the Human Sciences," Comparative Studies i n Society and History XIX (1977), pp.262-86. For a summary of the prominent nosological systems of the late eighteenth century, see "Nosographie" i n the Dictionnaire des Sciences Medicales ,36 (Paris, 1819) ,.'.pp. 206-65. 28 . chap. 10. 8 Foucault, chaps. 4-7. 9 F i g l i o , pp. 268-79; Foucault, pp.178-96 and As the contributors say, theirs i s "an inquiry into an inquiry." The basic primary source are the pro-ceedings of the medical inquiry which followed Turgot's, the Comptroller-General, arret du Conseil of 29 A p r i l 1776. The main aim here was to record the incidence of disease i n an attempt to e s t a b l i s h connections between cl i m a t i c conditions and epidemics i n .the various French regions. To formulate the survey i n such terms was to act on the be-l i e f that there were i n fa c t close l i n k s between the two. The notion has been l a b e l l e d i n various ways " ' l a doctrine neohippocratique, 1 ' l a doctrine climatises,' l a .theorie a e r i s t e s , 1 1 l a topographie medicale,' 'la nosologie geo-graphique'" and so forth. The d i r e c t o r and p r i n c i p a l correspondent of the inquiry was Vicq d'Azyr, the celebrated anatomist, and i t was launched under the auspices of the Societe Royale de Mddecine. See the introduction by Jean Meyer, "L'Enquete de l'Acade'mie de Me"decine sur les fepidemies 1774-1794," pp.9-20. For a further discussion of the Societe Royale de Medecine's function, see Hannaway, pp. 257-73. ^"Etude par ordinateur des donnees meteorologiques constitutes par les correspondants de l a S o c i e t e Royale de Medecine (1776-1792)," pp.21-135. 12 For a discussion on a g r i c u l t u r a l output and the weaknesses of subsistence a g r i c u l t u r a l productivity see A.J. Bourde, Agronomie et agrdnomes en France au 18 e s i e c l e v o l . 3; (Paris, 1967) , Ernest Labrousse et a l . , H i s t o i r e economique et sociale de l a France, II (Paris, 19 70); E. Le Roy Ladurie and J . Goy, "Presentation" i n Les  Fluctuations du produit de l a dime, (Paris, 1972) ; Michel Morineau, "Histoire sans f r o n t i e r e : prix et revolution agricole," Annales E.S.C. K (1969) , pp .403-423; Morineau, Les Faux-Semblants d'un d§marrage economique: agriculture  et dgmographique en France au 18^ s i e c l e de l'ahcien regime, (Paris, 1971). 13 Ladurie & Desaive, pp. 46-61. 14 Goubert, "Le phenomene epidemique," p.225 . ''"^J. Meyer, La noblesse Bretonne au 18 e s i e c l e , (Paris, 1966), p.456 . Meyer, "Le personnel medical," pp.186-90; Goubert, pp. 235-40. 17 Goubert, "Le phenomene epidemique," passim. 1 8 P e t e r , "Disease and the Sick," pp.117-118. 19 Ibid., pp. 118-120. 20 S p e c i f i c a l l y , Lebrun pointed out how environmental conditions created an atmosphere that increased the incidence of disease i n Anjou. Deplorable sanitary conditions in town and countryside were extremely conducive to a parasite's breeding habits. And, the close quarters between animal husbandry and people must have produced a p e s t i l e n t i a l atmosphere. See Lebrun, "Les conditions et les causes de l a mortalite," pp. 261-81. 2 1 I b i d . , pp . 281-99 . 2 2 I b i d . , pp. 471-80. 2 3 I b i d . , pp. 211-16, 228-29. 24 -Goubert, Malades et Medecms. For an i n t e r e s t -ing discussion on the nature of hygienic conditions see pp. 184-92. 25 The following l i m i t e d discussion on the study of death i s offered i n hope that the s o c i a l h i s t o r i a n w i l l begin to conduct si m i l a r research over a long period of time con-cerning the Western attitude toward health and i l l n e s s , the recovery from i l l n e s s , the desire of the i n d i v i d u a l to get well, and the sense of s o c i a l o b l i g a t i o n . 2 6 Aries, pp. 1-25. On the topic of attitudes toward death see Autour de mort, a special issue of the Annales  E .S .C. (1976), p. 3-132. P a r t i c u l a r l y Michelle Vovelle, "Les attitudes devant la'mort: problemes de methode, approaches et lectures d i f f e r e n t e s , " pp.120-32. Idem, Piete baroque et d e c h r i s t i a n i z a t i o n en Provence au XVIII e  s i e c l e , (Paris, 1973); and idem, Mourir autrefois : Attitudes c o l l e c t i v e s devant l a mort au XVTie-••et/'XVI Tig, s i e c l e s , (Paris, 1974) . 2 7 A r i e s , pp. 28, 44. 3 0 . Dupaquier, Introduction, p.9 3 . 29 Lebrun, Les hommes devant l a maladie," pp.3 9 1 - 4 1 5 . 30 This i n t e r p r e t a t i o n i s derived from Robert Heller, "Priest-Doctors" as a r u r a l health service in the age of the Enlightenment," Medical History ( 1 9 7 6 ) , pp. 3 6 1 - 3 8 3 . See also J.P. Goubert, "The Extent of the Medical Practice In France Around 1 7 8 0 , " Journal of Soc i a l History 1 0 , ( 1 9 7 7 ) p.4 1 6 . 3 1 On the position and the prestige of non-medical personnel i n eighteenth century France, see the work of f o l k l o r i s t M. B o u t e i l l e r , Medecine populaire d'hier et  d'aujourd'hui (Paris, 1 9 6 6 ) ; for a h i s t o r i c a l aspect see the c r i t i q u e by Robert Mandou i n Revue historique ( 1 9 6 7 ) , pp.2 1 4 - 1 7 . See also J.P. Goubert, "L'Art de guerir. Medecine savante et medecine populaire dans La France de 1 7 9 0 , " Annales E.S.C. XXXII ( 1 9 7 2 ) , pp.9 0 8 - 2 6 ; T.^Gelfand, "Medical Professionals and Charlatans. The Comite de Salubrite enquete of 1 7 9 0 - 9 1 , " H i s t o i r e Sociale-Social  History, ( 1 9 7 8 ) pp.6 2 - 9 7 ; and Goubert, Malades et Medecins, pp. 2 3 4 - 4 8 . 32 This point i s also made by Gelfand, pp. 8 2 - 8 3 ; and Goubert, "L'Art de guerir," pp.9 1 1 - 1 2 . In addition, they argue that "empirics" or i l l e g a l p r a c t i t i o n e r s challenged the competence of the medical p r a c t i t i o n e r to mitigate a patient's i l l n e s s . For a discussion on t h i s topic, see Gelfand, pp. 7 8 - 9 2 ; Goubert, "L'Art de giuerir," pp.9 1 9 - 2 1 ; and idem, Malades et Medecins, pp. 2 4 0 - 4 8 . 33 -See Alan Forrest, "La Revolution et les hopitaux dans le department de l a Gironde," Annales du Midi 8 6 , ( 1 9 7 4 ) , pp.3 8 1 - 4 0 2 ; P. Loupes, "L'Assistance p a r o i s s i a l e aux pauvres malades dans les diocese de Bordeaux au dix-huitieme s i e c l e , " i b i d , 84 ( 1 9 y 2 ) , pp.3 7 - 6 1 ; Pierre Lunel, "Pouvoir royal et sante publique a l a v e i l l e de l a Revolution: L'exemple du Roussillon," i b i d , 8 6 , ( 1 9 7 4 ) , pp. 3 4 5 - 8 0 ; and Murial Jeorger, "La Structure h o s p i t a l i e r e de l a France sous 1'Ancien Regime," Annales E.S.C. XXXII ( 1 9 7 7 ) , pp. 1 0 2 5 - 5 1 . For an excellent s o c i o l o g i c a l model on the doctor-patient r e l a t i o n s h i p see I . Waddington, "The Role of the Hospital i n the Development of Modern Medicine: A S o c i o l o g i c a l Analysis," Sociology 7 ( 1 9 7 3 ) , pp.2 1 1 - 2 4 . See also E.M. Sigsworth, "Gateways to Death? Medicine, Hospitals and Mortality 1 7 0 0 - 1 8 5 0 , " i n Science and Society, P. Mathias ed., (London, 1 9 7 2 ) , pp.9 7 - 1 1 0 . Ackerknecht,. chapter 1 . 3 1 . 3 5 Foucault, chaps. 1 - 7 . 3 6 Jewson, pp. 234-35. 3 7 For a discussion on the impact of the hospital structure on medical practice see, F i g l i o , pp. 280-81, p a r t i c u l a r l y p.280. 3 8 M i l l e r , pp. 20-21. 3 9 I b i d . , p.25. 4 0 I b i d . , pp. 240-66. 41 P.E. Razzell, "Population Change i n 18th century England," Economic History Review 18 (1965), pp. 312-32. 4 2 Razzell, p . v i i . 4 3 Oiva Turpsinen, "Mortality from Smallpox, Measles and Whooping Cough In Finland, 1751-1865," i n International Colloquium i n B e r l i n (West), (1978), pp. 20-2 3; and A l f r e d Perrenoud, "Deux cents ans de variole a Geneve. Contribution a X'histoire- cyclique des maladies," i b i d . , pp. 30-33. The s t a t i s t i c a l study of Finland i s based on the exp l o i t a t i o n of parish registers and national s t a t i s t i c s . The demographic data for Geneva i s derived from the mortality b i l l s and national s t a t i s t i c s which began i n 1580 and ceased i n 1830. p.7 4 4 This point i s made by McKeown, Population, 45 Ibid., p.3. According to McKeown, "The reasons for the increase of population have had r e l a t i v e l y l i t t l e attention, and i t has been assumed rather than demonstrated that i t was associated broadly with advances in. medicine and improved l i v i n g conditions. There has been no serious attempt to es t a b l i s h the time when these influences became e f f e c t i v e , or to dis t i n g u i s h between the very d i f f e r e n t e f f e c t s of increased food supplies, improvements i n hygiene, immunization and therapy under the term (medical measures). For although doctors have contributed to a l l these, i t i s important to separate changes i n the physical environment from s p e c i f i c pre-ventive and therapeutic measures applied to the i n d i v i d u a l . " 46 This point i s derived from McKeown, i b i d . , p.107, who noted: "Among reasons given...for r e j e c t i n g the conclusion that v a r i o l a t i o n [inoculation] reduced mortality from smallpox, was the observation that control of the disease has been achieved by surveillance and vaccination of contacts rather than by mass immunization." 4 7 Marc Barblan, "La Variole dans l e Departement du Leman en 1811 (d'apres les registres de l a conscription napoleonienne)," Gesnerus 31 (1974), pp.193-220. 4 8 I b i d . , p.202. 49 -La Condamine, "Memoire sur 1 1 i n o c u l a t i o n de l a p e t i t e verole," H i s t o i r e de 1'Academie Royale des Sciences (Paris, 1754), p.644 . 50 Ibid., p.615. 5 1 0 n the Royal Society, see Henry Lyons, The Royal Society 1660-1940. A History of i t s Administration  under i t s Charters, (Cambridge, 1944). The contrasting organization of the Academie des Sciences emerges c l e a r l y i n Roger Hahn, The Anatomy of a S c i e n t i f i c I n s t i t u t i o n : The Paris Academy of Sciences 1666-1803. (Berkeley, 19 71). 5 2 See the biographical account of La Condamine by Pierre Conlon, "La Condamine the i n q u i s i t i v e , " i n Studies on V o l t a i r e and the 18th Century LV, (1967), pp.361-94. This a r t i c l e has placed considerable emphasis on La Condamine's e f f o r t s to widen the horizons of man's knowledge most notably i n the natural sciences. Although Conlon has c i t e d the works of La Condamine i n r e l a t i o n to the campaign for smallpox inoculation, the approach has contributed l i t t l e to our understanding of how La Condamine's ideas about the practice r e f l e c t e d the opinion of "enlightened" men to such key issues as p o l i t i c a l economic theory and practice and public health. See also Hahn, pp.70, 89-90, 109. 5 3Hahn, pp. 35-38; 84-90; C y r i l B.O'Keefe, Contemporary Reactions to the Enlightenment 1728-1762 (Geneva, 1974), chap. 4. See also the excellent a r t i c l e s i n the volume edited by Francois Furet et a l . , Livre  et Societe, I (Paris, 1965), passim. For a f u l l e r understanding of the i n s t i t u t i o n a l i z e d character of the academician during the course of the eighteenth century see the in t e r e s t i n g study on the Paris Academy of Sciences by Roger Hahn, passim. 55 For a discussion on thi s topic, see McKeown, pp.7-9. 56 This point i s made by C y r i l B.OJKeefe, p.5, who noted: "One of the most disconcerting features of the review a r t i c l e s to modern readers i s the almost complete lack of c r i t i c i s m which i s regarded today as a necessary element of a review a r t i c l e . " Chapter I THE TECHNIQUES OF INOCULATION The smallpox inoculation i s probably nearly as old as the disease i t s e l f , and reports of i t s existence appear i n the European l i t e r a t u r e as early as the l a t e seventeenth century. Inoculation seems to have been a long-standing folk practice i n China, India, North A f r i c a and regions of Arabia. In a l l these countries, inoculation was probably perfected over a period of hundreds of years before i t came to the attention of European doctors and penetrated the repertory of t h e i r o f f i c i a l l y approved techniques during the eighteenth century."'" Near Eastern folkways, for example, had provided the practice of inoculation with a f u l l complement of myth and r i t u a l by the time learned Europeans f i r s t i n -vestigated the matter. The person to be inoculated was viewed as "buying the smallpox"; the method was to transfer the i n f e c t i o n by introducing matter from a small-pox pustule into a s l i g h t i n j e c t i o n made i n the patient's skin. And, as we s h a l l see, this was the method of inoculation adopted, though s l i g h t l y modified, by the European medical profession i n the eighteenth century. The f i r s t s i g n i f i c a n t medical account of ': inoculation to appear, i n Europe was written by the Greek doctor, Emmanuel! Timoni, a widely reproduced abstract which was f i r s t published i n the Philosophical Trans-actions i n 1714. Timoni, who took a medical degree from the famous medical school at Padua and practiced at Constantinople, claimed that of the "thousands" of people who had been inoculated during the previous eight 2 years "none have been found to die of the operation." He admitted, however, that occasionally patients de-veloped a severe case, of smallpox, and i n 1701 when a serious outbreak of smallpox took place, four out of f i f t y cases had contracted smallpox as a r e s u l t of inoculation 3 "near the confluent sort." Yet, the sudden onset of symptoms led to a suspicion that "these four had caught 4 the common Small-Pox before the I n c i s i o n was made" a problem which affected every form of smallpox prophylax-:". s i s . Besides t h i s complication, Timoni stated that the pustules r e s u l t i n g from inoculation were " d i s t i n c t , few and s c a t t e r 1 d ; commonly 10 or 20 break out; here and 5 there one has but two or three, few have 100." These mild r e s u l t s from inoculation were almost c e r t a i n l y achieved through the technique of i n j e c t i o n employed; Timoni described this as follows: the Operator i s to make several l i t t l e Wounds with a Needle, i n one, two or more . Places of the S k i n , . ' t i l l some Drops of Blood follow, and immediately drop out some Drops of Matter i n the Glass, and mix i t well with the Blood issuing out; one Drop of Matter i s s u f f i c i e n t for each Place Pricked. These Punctures are made i n d i f f e r e n t l y i n any of the fleshy Parts, but succeed best i n the Muscles of the Arm or Radius. The Needle i s to be a three 'edged Surgeon's Needle; i t may likewise be perfor'd with a Lancet: The. Custom i s to run the Needle transverse, and r i p up the skin a l i t t l e , that there may be a convenient d i v i d i n g of the Part, and the mixing of the Matter with the Blood more e a s i l y perform'd.^ The conclusions reached by Timoni about the safety and method of inoculation i n Turkey were con-firmed by a number of independent witnesses, both medical and non-medical. Peter Kennedy, a Scot t i s h surgeon who had practiced at Constantinople, stated i n a book written i n 1715, that he had been informed by doctors and merchants l i v i n g there, "that of the Number of two thousand, which had then l a t e l y under-gone that Method [of inoculation], there were not any 7 more than two who died. S i m i l a r l y , the Greek doctor, Jacob P y l a r i n i described i n an account published i n the Philosophical Transactions for 1716, how inoculation had been introduced into Turkey i n 1701 from Thessaly, and described the method of inoculation as follows: the Greek woman...pricks the middle of the Forehead, and the Temples at the Root of the Hairs; as also the Chin and both the Cheeks, with a s t e e l or golden Needle, not thrusting i t straight, but obliquely, and separating the Skin a l i t t l e with a sharp Point from the Flesh below, Then with the same Needle she introduces the Pus into the l i t t l e O r i f i c e s , and t i e s a Bandage over the Parts...The eruption i s almost always of the d i s t i n c t kind, and the Pustules not numerous; but frequently twenty or t h i r t y , r a r e l y a hundred, and very seldom two Hundred.^ The i n j e c t i o n i n the forehead, chin, cheeks and so forth was a residue of the C h r i s t i a n b e l i e f that '• in c i s i o n s , made i n the pattern of a cross, would help to insure success. Though we would fi n d t h i s aspect of the practice unusual, the actual technique of inoculation appears to have been very sound and had . excellent r e s u l t s . The mildness of inoculation i n Turkey was confirmed by Charles Maitland, who was chief surgeon to the English embassy at the time Lord Montagu was ambassador: "The Pustules, whether many or few never l e f t any Marks or P i t s behind them, except only i n 9 the Incisions, or Parts Ingrafted." Maitland assisted i n the inoculation of Lady Mary Montagu's son at Constantinople i n 1717; his account of t h i s second known inoculation of English children .(two children of an Embassy O f f i c i a l had been previously inoculated) i s not only of h i s t o r i c a l i n t e r e s t , but marks the beginning of a practice that had a serious and long-l a s t i n g e f f e c t on the history of inoculation i n both England and France. From the very beginning of the practice of inoculation by the English medical pro-fession, a lancet, rather than a needle was used, and this affected, the depth with which the i n c i s i o n s were made. The success of the practice was further confirmed by J.N. Boyer, a medical p r a c t i t i o n e r who presented an 38. inaugural dissertation, at the University of Montpellier i n 1717. He concluded his support for the new method as follows: Le t r i b u t que tout homme doit payer, au moins une f o i s en sa v i e , a l a petite verole, paroissant i n e v i t a b l e , i l est plus a propos d 1 e x c i t e r une benigne par cet a r t i f i c e , que d'abandonner une a f f a i r e de cette importance aux soins de l a nature, qui dans l a plupart d'autres ces agissant en mere tendre, semble souvent dans cel u i - c i ne se montrer que sous les dehors d'une c r u e l l e maratre.H I t i s s i g n i f i c a n t to note that t h i s address i n support of the medical practice was v i r t u a l l y ignored by the partisans of inoculation in the early eighteenth century and i t was not noticed u n t i l 175 8 by La Condamine i n his second memoir. One of the problems concerning the method of i n -oculation was that the French medical profession found i t d i f f i c u l t to accept t h i s practice because i t had not been discovered by one of t h e i r own members, but by people with no pretension to the conventional medical 12 wisdom of the period. The defensiveness of the medical profession sometimes resulted i n extreme arrogance so that one of the e a r l i e s t opponents of inoculation could say: "En Angleterre, c'est une V i e l l e Sage-Femme. qui en a i n s t r u i t c e l u i qui nous a valu cette merveilleuse decouverte ... L'Inoculation est une pratique populaire, un remede de bonne femme, 39 . ramasse de parmi un peuple ignorant; and on veut 13 mettre cette pratique en valeur." In f a c t , most of the innovations i n the technique of inoculation came from obscure surgeons and doctors to whom contemporaries 14 contemptuously referred as "empirics"; t h i s i s just one i l l u s t r a t i o n i n the history of medicine and disease of how important p r a c t i c a l medical discoveries have occurred through empirical observation or chance, rather than the o r e t i c a l understanding. The f i r s t inoculation i n Europe was of Lady Montagu's daugher i n A p r i l 1721, which was performed by Maitland i n London. The operation was successful and the patient had less than one hundred pustules as a r e s u l t of her i n o -15. culationv Maitland played a s i g n i f i c a n t role i n the introduction of inoculation into England, and he was responsible for the experimental inoculation of the six Newgate prisoners i n the autumn of 1721, the success of which helped to persuade the royal family and the 16 aristocracy to have t h e i r own children inoculated. Un-fortunately, Maitland l e f t no account of his technique, but i t i s certain that he made deep i n c i s i o n s with a lancet; he described how t y p i c a l l y the i n c i s i o n s he made 17 led to "a vast Discharge" of matter, a symptom known to be associated with deep i n j e c t i o n s . This conclusion was confirmed by an eyewitness account, of Maitland's « inoculations of the Newgate pri s i o n e r s : "The Incisions 18 were long and large." The r e s u l t of t h i s method was much severer than that practiced by Timoni and P y l a r i n i i n Turkey; several children had 300 pustules and more, 19 while one had "above two Thousand." This was the st a r t of a f a i r l y severe form of inoculation, which was used by a l l p r a c t i t i o n e r s i n Europe u n t i l Theodore Tronchin, a Genevan doctor, modified the technique i n the 1750s, and Angelo G a t t i , an I t a l i a n doctor who practiced at Constantinople, made a key innovation of technique i n the 176 0s. There were two main reasons why the early English inoculators adopted the deep i n j e c t i o n technique: an anxiety about whether inoculation produced a form of smallpox (even some French contemporaries questioned 20 whether the l i g h t Turkish form would achieve t h i s ) , and the b e l i e f that the "poison" of smallpox had to be discharged through an "issue" for a successful outcome. The l a t t e r was part of a c l a s s i c a l humoral theory of smallpox, which assumed that everyone inherited the "seeds" of the disease, which had to be expressed through the eruption of smallpox before true health could be 21 achieved. Some of the early inoculators claimed, how-ever, that the deeper inje c t i o n s were also more success-f u l because of the copious discharge at the sight of i n c i s i o n than were the l i g h t e r forms of inoculation. For example, Nettleton, who was one of the f i r s t to practice inoculation on any scale,wrote i n 1722: I generally found, that i n those who discharged most th i s way, the Fever was more s l i g h t , and the Small Pox fever, tho' I have known some do very well when these places have only appeared very red, but have scarce run anything at a l l , as i t usually happens, when the Incision i s made so s u p e r f i c i a l as not to cut thro' the Skin.22 This conclusion was based, however, on only f o r t y cases, and the lack of any systematic experimental evidence meant that Nettleton could i n e f f e c t assert opposite propositions i n the same sentence, without f e e l i n g a need to further c l a r i f y the po s i t i o n . Contemporaries were perhaps predisposed to accept the conclusion about the benefits of deep i n c i s i o n s because of th e i r t h e o r e t i c a l b e l i e f s . The p r a c t i t i o n e r s of inoculation i n the 1750s re a l i z e d some of the problems that very deep inje c t i o n s created, and Tronchin, who was one of the f i r s t to practice inoculation on any scale i n France, described the new technique as follows: Quant a 1'operation, on f a i t aux deux bras dans l a pe t i t e externe and moyenne, au- n dessous de 1' i n s e r t i o n du muscle deltoide, pour ne point gener l a l i b e r t y du mouvement, une i n c i s i o n de moins d'un pouce de long s i peu profonde, qu'elle entame a peau. On insere dans l a p l a i e un f i l de l a meme longueur, impr^gne de l a matiere d'un bouton mur and sans rougeur a sa base, p r i s d'une p e t i t e v§role naturelle s o i t a r t i f i c i e l l e , d'un enfant sain; on qouvre le tout d'un plumasseau, d'un emplaitre de diaplume, & d'une,compresse qu'on : a s s u j e t t i t avec une bande.23 Moreover, the symptomatic advantage claimed for the new l i g h t e r method of inoculation was that i t led to less soreness at the s i t e of i n j e c t i o n and fewer inflammatory 24 complications,' nowhere i n the l i t e r a t u r e i s i t stated that the severity of the inoculated smallpox - the number of pustules and so forth - was affected. Although the newer l i g h t e r method was apparently adopted by a l l popular inoculators i n the 1750s and mid-1760s, the symptoms re-s u l t i n g from these inoculations were s t i l l severe. For instance, a l e t t e r i n Frtron's L'Ann^e L i t t t r a i r e re-vealed the severity of symptoms as a r e s u l t of the technique i n 1765: M. Lami de l a Perriere f i t inoculer l e 8 Janvier deux de ses enfans par M. Acton... L'un & 1*autre des.inoculds eurent une pe t i t e v t r o l e tres^discrete; les pustules etoient grosses, mais peu abondantes; and ces enfans se portoient a merveille, lorsqu'une nouvelle f i e v r e , precedee and accompagnte d 1assoupissement and de vomisse-ment, survint l e quinzieme jour de 1'Inoculation. Le corps fut couvert de boutons m i l i t a i r e s rouges; l a peau devint brulante, l a gorge s'embarrassa, s'enflamma; les glandes du c o l se gonflerent; tout l e v o i l e du p a l a i s , les amigdales & l e 2 5 p a v i l i o n du pharinx furent charges d'aphtes. The key change i n technique and r e s u l t i n g symptomology occurred with G a t t i , as we s h a l l now see. Angelo Gatti appears to have started the. practice as an inoculator i n about 1750. Kurt Sprengel, a medical h i s t o r i a n , gave the following account of his new method: Quant a l ' o p 6 r a t i o n elle-meme, i l l a p r a t i q u a i t avec une epingle trempee dans le pus variolique, q u ' i l i n s i n u a i t a diverses reprises au dessous de l'6piderme du bras. II pensait qu'on ne doit jamais introduire que f o r t peu de matiere, parce que le nombre des pustules proportionne a 1 *abondance du v i r u s : i l remplacait quelquefois aussi ce dernier par des croutes varioliques pulv6ris£es.26 Since Gatti used a needle rather than a lancet, his technique appears to have been i d e n t i c a l to that practiced in Turkey. Given that i t became generally agreed that the Gatti method was a key change i n technique, i t i s clear that much l i g h t e r e f f e c ts were produced by i n -jecting virus into the epidermis, or, at most, the boundary between the epidermis and dermis, rather than 27 f u l l y into the dermis. The improvements i n technique are obviously c r i t i c a l i n assessing the safety of inoculation. However, there i s one major obstacle which must be surmounted before we can discuss the evidence on the severity of inoculated small-pox: the problem of people contracting natural smallpox before t h e i r inoculation. We have already noted how Timoni had experienced t h i s d i f f i c u l t y when attempting to assess the e f f e c t s of inoculation i n Turkey, and i t was a problem for anyone attempting to evaluate t h i s form of smallpox prophylaxsis. French inoculators considerably compounded th i s problem by introducing a r e l a t i v e l y lengthy period of medical preparation before inoculation - a period which obviously l e f t those to be inoculated vulnerable to natural i n f e c t i o n , p a r t i c u l a r l y during a period of smallpox epidemic. Ga t t i wrote i n 1766 an 44. account of how the European inoculators introduced the practice of preparation:" Ever since inoculation has been received i n Europe, the pr a c t i t i o n e r s have been of the opinion that the esse n t i a l advantages of a r t i f i c i a l and natural smallpox were, 1. the preparation; 2. the discharge of the variolous matter by means of the wounds; 3. the assistance of a r t i n a disorder which i s known as soon as i t appears. A l l inoculators have said, pre-pare your subjects, procure an outl e t to the venom; be attentive to administer every help of art, when the disorder shows i t -self.28 The major reason for the introduction of medical pre-paration again appears to have been due to a b e l i e f i n humoral pathology, though La Condamine strongly implied that i t was very much i n the medical profession's 29 economic i n t e r e s t to adopt th i s measure. However, there was no single systematic and consistent body of be-l i e f s on the humoral pathology of smallpox which can be quoted from the l i t e r a t u r e . 3 * ^ Preparation took the form of a r e s t r i c t e d d i e t , purging and blood-letting, and these were, measures which were used by the French medical profession i n the treatment of natural smallpox before the advent of inoculation. Tronchin resorted to dietary measures i n the treatment of 31 his cases, and Samuel-Andre Tissot, a Swiss, doctor and partisan of inoculation, j u s t i f i e d preparation i n these terms: Quand 1'enfant est tres-vigoureux paroit sanguin, on d o i t l u i f a i r e une ou deux saignees, and l u i f a i r e prendre du n i t r e s o i r and matin, pendant tout l e terns de l a preparation: ces precautions sont n^cessaires pour prevenir 1'inflammation que le venin de l a p e t i t e verole produit tres-ais£ment dans des corps s i vigoureux.32 What emerges from th i s quotation p r i n c i p a l l y i s a notion of "constitutions" which are too "high" — inflaming the virulence of the disease by energizing i t - or too "low," 33 so as to be incapable of expelling the i l l n e s s . T issot, l i k e his contemporaries appears to have been most concerned with constitutions which were too high. According to the conventional medical wisdom, constitutions which were thought to be too high were robust and active ones, and the disease was believed to. be: inflamed: . bye animal.. foods --..but 34 reduced by a r e s t r i c t e d d i e t , bleedxng and purging. In addition, Tissot required patients: a ne leur donner que peu de viande, & seulement des viandes blanches; mais a les f a i r e vivre principalement de legumes & des f r u i t s , & a ne leur l a i s s e r boire que l'eau, ou du l a i t coupe" avec le l'eau, ou du p e t i t - l a i t . 3 5 This period of preparation was a r e l a t i v e l y lengthy a f f a i r , and Tissot writing as late as 1787, referred to the necessary preparation as follows: "un choix d'alimens qui ne soient ni f o r t nourrissans, n i gras, n i s a l t s , 3 6 ni acres, pendant quinze jours ou t r o i s semaines." For the most part, the medical profession appears, however, to have r e a l i z e d the irrelevance of much of the preparatory measures, and Tronchin writing i n 17 65 about the history of inoculation i n France and Europe stated: Les enfans ont a peine besoin de preparation: quelques jours de regime &:.une;:ou; deux •.purgations: suf f isent ; rarement on emploie l a saignee.37 This simplication of preparation does seem - at l e a s t among children - to have led to a shortening of time involved, and i t played a s i g n i f i c a n t r o l e i n mitigating the great p o t e n t i a l dangers to patients and people being exposed to smallpox. The f i r s t inoculator to completely dispense with preparation was G a t t i . Sprengel described his method and noted: Sa methode e t a i t a tous egards extremement simple. Comme i l n'inoculait, autant q u ' i l e t a i t en son pouvoir, que des personnes bien portantes, i l n'employait jamais de preparation, ou s ' i l y trouvait contraint, i l se gardait surtout de recourir aux de b i l i t a n s et aux pur g a t i f s . His innovation was merely a return to the Turkish practice and i n one sense was an inevitable l o g i c a l development leading to a greater s i m p l i f i c a t i o n of inoculation. However, some more conventional medical p r a c t i t i o n e r s were reluctant to e n t i r e l y abandon preparation. Gandoger de Foygny, who practiced at Nancy, complained i n 1768 that, i l y a des sujets qui, sans etre actuellement malades, doivent f a i r e quelques remedes, avant que d'etre inocules. Cette preparation concerne 1., les sujets dont l a constitution est trop f o i b l e , trop d e l i c a t e ; 2., alors i l faut f o r t i f i e r , ou l e temperamment du sujet, s ' i l . ' est. -trop f o r t , & 11 'faut l : ' ; a f f l o l b l i r . .-, 3., enfin i l peut y avoir quelque vice p a r t i c u l i e r qu' i l faut corriger.39 47. Although there i s some substance of truth i n th i s state-ment, i t i s simply an i l l u s t r a t i o n of how the medical profession had d i f f i c u l t y i n agreeing upon a standard medical procedure that was obvious to many other ex-perienced inoculators because of the i r attachment to the notions of contemporary conventional medical wisdom. Given the variations i n technique and methods of preparation discussed so far i n t h i s chapter, the evalua-tion of the severity of the symptoms r e s u l t i n g from ino-cul a t i o n against smallpox, obviously becomes d i f f i c u l t . A review of the available l i t e r a t u r e on th i s problem does lead to ce r t a i n tentative conclusions, but these must always be set i n the context of the various complicating factors already discussed. There are two important ways of evaluating the severity of the results of inoculation: f i r s t l y , the number of pustules, amount of fever, and other symptoms of smallpox, and secondly, the proportion of people dying a f t e r inoculation. We s h a l l discuss these i n turn. De Baux, a doctor who practiced inoculation i n Avignon gave a l i s t of the number of pustules i n two of his inoculated cases i n 1760 as follows: L'enfant a e u 45 a 50 boutons, point de fievre de suppuration: l a huitieme jour de l ' e r u p t i o n , i l d t o i t debout. Un f i l s unique, age" de sept ans, ne d'un pere asthematique, a eu le meme f o r t que l e premier: i l a eu seulement quelques boutons de plus.40 This l i s t i s confirmed by T i s s o t who also wrote a b r i e f 4 8 . account on the number of pustules r e s u l t i n g from his ino-culated cases: Le nombre ordinaire des boutons est entre cinquante & quatre cent. J'en a i vu plusieurs f o i s beaucoup moins de cinquante; & t r o i s ou quatre f o i s , autant que dans une p e t i t e v^role discrete tres abondante.41 The v a r i a t i o n i n the number of pustules may have been pa r t l y a function of differences i n technique used by De Baux and Tissot - the cases with the smallest number of pustules may well be those where the l i g h t e s t i n c i s i o n s were made -but the important o v e r a l l conclusion to emerge from the b r i e f l i s t s , i s the somewhat greater severity of symptoms than reported from Turkey. I t was generally acknowledged, however, that the Gat t i method reduced the r i s k s of dying from inoculation. Gatti i s reported to have inoculated 200 people between 1763 (when he f i r s t started his practice i n France) and 42 1765, without a single death, and an extract i n the Journal Encyclopd'dique claimed i n 176 9 that G a t t i had ino-culated at least 200 people i n that year without a single 43 f a t a l i t y . Although i t i s impossible to assess t h i s claim d i r e c t l y , even those with a vested i n t e r e s t i n denying the success of inoculation did not deny the spread of the G a t t i method. This led Baron Grimm, the German l i t e r a r y and s o c i a l observer who held the philosophe point of view, to remark i n 1767: "Je suis convaincu que cette methode 44 f i n i r a par etre g£n£ralement adoptee dans toute 1'Europe." This tentative conclusion was confirmed i n France by an independent p r a c t i t i o n e r i n Nantes who used the Gatti method and stated i n 1774: Partisan de 1'inoculation, & Inoculateur moi-meme, cette nouvelle me fut d'autant plus agreable, que, temoin des ravages affreux que l a va r i o l e naturelle ne cesse d'exercer tous les ans dans ma patrie je des i r o i s de plus en plus de l ' y v o i r e t a b l i e . II e t o i t bien etonnant qu'aucun m^decin, ou chirurgien de Nantes ne se fut adonne a l a pratique de 1'inoculation; mais, s o i t qu'elle eut peu de partisans declares parmi ces MM., s o i t q u ' i l f a l l u t un Stranger, un I t a l i e n meme, pour decider l a confiance des Nantois.45 These examples do not mean that people ceased to believe that inoculation did not spread natural smallpox. In fact, t h i s appears to have existed i n the late eighteenth century. For instance, J.P. Goubert noted: S i l'on en juge d'apres ces documents, les "prdjugts" populaires contre 1'inoculation n' etaient pas sans fondements: i l se pourrait meme que certaines epidemies de v a r i o l e , par exemple, en 1773, 1779 et 1783 aient ete, au moins partiellement, causees par les inocul£s.46 But during the course of the late eighteenth century, i t i s highly probable that natural smallpox as a r e s u l t of inoculation was becoming a rare event. As we s h a l l see, th i s was pa r t l y due to the recognition of the infectious nature of the disease and measure of i s o l a t i o n being i n -troduced to prevent i t s spread, such as the provision of i s o l a t i o n of patients at home, together with improved housing and n u t r i t i o n of the poor. This and the somewhat r i g i d quarantine regulations introduced, p a r t i c u l a r l y 50. during epidemic outbreaks, to prevent the importation of smallpox into the town, were probably more important measures than inoculation i n determining the diminution i n incidence of natural .smallpox during the late eighteenth century. I t might be thought that some of the foregoing evidence suffers from a lack of analysis, and that an element of exaggeration has crept into some of the accounts of the success of inoculation. Perhaps, there i s a substance of truth to these accusations. This chapter, however, has attempted to demonstrate how the methods of inoculation and the severity of i t s techniques affected the extent of the practice during the eighteenth century. NOTES Theodore Tronchin, a r t . "Inoculation," Encycl'opedie p.755. Tronchin wrote: "Son epoque n'a point de terme f i x e en Afrique sur les cotes de Barbarie, sur c e l l e s du Senegal...en divers endroits de l'Inde... enfin a l a Chine, ou e l l e a recu une forme p a r t i c u l i e r e . " 2 Emmanueli Timoni, "An Account, or History of the Procuring the Small Pox by Incision; or Inoculation. As i t has for some Time Been Practised at Constantinople," Philosophical Transactions, XXIX (April-June 1714), pp. 7 2-82. 3 Ibid., p.72. 4 I b i d . , p.74 5 I b i d . , p.74 ^Ibid., p.73 7 Peter Kennedy, An Essay on External Remedies (London, 1715), p.155. g Dr. Jacob P y l a r i n i , "Nova et tuta excitandi per transplatationem methodus; nuper inventa et i n usum tracta, " Philosophical Transactions, XXIX (Jan.-Mar.1716), pp. 393-99, p a r t i c u l a r l y , p.393, Trans. W.J. Dusing. q Charles Maitland, An Account of Inoculating  the Smallpox (London, 1723), p.7. For a s i m i l a r discussion on the Maitland method see Tronchin, p. 770. 1 0 T r o n c h i n , p. 770; La Condamine, "Second Memoire sur 1'inoculation de l a petite verole, contenant l a suite d' h i s t o i r e de cette methode & de ses progres de 1754 a 1758," H i s t o i r e de 1'Academie Royale des Sciences (Paris, 1758), p.442. 1'1"La Condamine, "Second Memoire, " p .443 . 12 This point i s made by M. Bariety and C. Coury, H i s t o i r e De La Medecine (Paris, 1963), pp.483-84, 585-87. 13 Philippe Hecquet, Observations sur l a saignee  du pied et sur l a purgation ou commencement de l a petite  verole, des fievres malignes & des malades. Preuves de  decadence dans l a pratique de medecine, confirmees par de  justes raisons de doute contre 1'inoculation. (Paris, 1724) , p.355. 14 On the topic of "empirics", see J.P. Goubert, "L'Art de guerir. Medecine Savante et Medecine populaire dans l a France de 1790," Annales E.S.C. (1977) , pp.912-18; T. Gelfand, "Medical Professionals and Charlatans. The Comite de Salubrite enquete of 1790-91," H i s t o i r e Sociale-S o c i a l History (1978) , pp.62-63; F. Lebrun, Les Hommes  et l a mort en Anjou aux 17 e et 18 e s i e c l e s (Paris, 1971), pp. 404-05; and J.P. Goubert, Malades et Medecins; en Bretagne 1774-1790 (Paris, 1974) , pp. 234-42. 15 Maitland, pp. 8-10. •I c S i m i l a r l y , news of the Newgate experiments reached the French court and medical c i r c l e s i n 1721 c f . Anonymous Letter of 12 July 1721 i n Correspondants de l a  Mse. de Balleroy I I , p. 341. Cited i n G. Lanson. Lettres  Philosophiques I, new e d i t i o n by Andre Rousseau, (Paris, 1964), p. 137 note 1. 1 7 M a i t l a n d , p.24. 18W. Wagstaffe, M.D., A Letter to Dr. Friend  Showing the Danger and Uncertainty of Inoculating the  Smallpox (London, 1922), p.25. 19 Ibid., pp.30-31. 20 See, for example, Hecquet, pp. 356-57. 21 . • For a discussion on the c o n f l i c t i n g viewpoints of contemporaries toward th i s medical theory see Genevieve M i l l e r , The Adoption of Inoculation for Smallpox i n England and France (Philadelphia, 1957), pp.244-260. 53. 22 Thomas Nettle tori/ M. D. "A Letter to Dr. Jurin," Philocophical Transactions, XXXI (1720-27), p.38. 23 Tronchin, p.758. 24 Ibid, p.758. Tronchin noted the symptomatic disadvantages of the deep i n c i s i o n s as follows: " L ' i r r i t a t i o n des biceps sur lequel se f a i t l ' i n c i s i o n , augmente tres-souvent l a f i e v r e & cause jusques sous l ' a i s s e l l e une douleur quelquefois vive & presque toujours inquietante." 25 "Lettre sur 1'inoculation," L'Annee Litt<§raire VI (1765), pp.328-29. 2 6 Kurt Sprengel, H i s t o i r e de l a medecine VI (Paris, 1815), pp.60-61. 27 "Variole," i n Dictionnaire des Sciences  Medicales 57 (Paris, 1821), p.82."...ces i n c i s i o n s , de quelque lignes de longueur, ne devaient comprendre que l'epiderme, et i l e t a i t d t a b l i en principe que 1'op^rateur devait attendre quelques instans avant de v o i r le sang. Des accidens t e r r i b l e s avaient appiris combien i l e"tait dangereux d'enfoncer trop profond^ment 1'instrument tranchant: on avait vu, dans ce cas, le p l a i e s se trans-former en ulceres du plus mauvais caratere...Les i n -c i s i o n s ne doivent doncfendre que l'epiderme; on couche dans leurs longueur un f i l imbibe* de l a matiere vario-'. lique." For a summary of the prominent methods of ino-culation see "Variole," pp.79-85. 2 8 Angelo G a t t i , New Observations on Inoculation, (London, 1768), pp.8-9. Cited i n Charles Creighton, The History of Epidemics i n Great B r i t a i n , 2nd ed., (London, 1965), pp.469-70. 29 La Condamine, "Memoire sur 1'inoculation de l a p e t i t e v£role," H i s t o i r e de I'Academie Royale des Sciences (Paris, 1954), p.770. For a general discussion on t h i s subject i n r e l a t i o n to inoculation see chapter three. "^This point i s confirmed by La Condamine, Ibid., p.637 who remarked: "Je parle i c i germe de l a pe t i t e v i r o l e d'apres 1'id£e recue d'un grand nombre de medecins, & niee par d'autres, parce que toute th6orie en medecine est probl^matique." For a l i s t of the c l i e n t e l e attended to by Tronchin i n the 1750s see La Condamine, "Second Mdmoire," p.455. 32 Samuel Tissot, Avis au peuple sur sa sante (Lausanne, 1787), p.270. 33 On t h i s topic, see J.P. Peter, "Disease and the Sick at the End of the Eighteenth Century," trans. E. Forster i n Biology of Man i n History, R. Forster and 0. Ranum eds., (Baltimore, 1975), pp.100-107; and M i l l e r , pp.252-258. 34 This point i s confirmed by Tronchin, p.75 8, who wrote: "A l'egard des adultes, comme i l s'agit de disposer le corps a une maladie inflammatoire, plus l e sujet est sain.& vigoureux, plus generalement parlant ses forces ont besoin d'etre a f f o i b l i e s par l a saignte, l a diete, 1'usage des remedes ra f r a i c h i s s a n s . On y j o i n t quelque purgatifs & quelquefois l e s bains. II est a propos de consulter un medecin sage, qui connoisse le temperament de c e l u i q u ' i l dispose a I'inoculation, & qui puisse l u i proscrire un regime convenable." 3 5 T i s s o t , p. 269. 3 6 I b i d . , pp. 268-69. 37 Tronchin, p. 758 . Sprengel, pp.60-61. For a s i m i l a r discussion on Gatti's method see Grimm ,Correspondance, L i t t e r a i r e , Philosophique et C r i t i q u e , VII, '(Paris, 1877) , p.319, who wrote: "II pretend q u ' i l ne faut pas preparer, parce que le sujet qu'on veut inoculer d o i t etre eh etat de sante, et que s ' i l est malade, i l faut le guerir. Cet etat de sante ttant l e meilleur etat possible pour donner l a p e t ite verole." 39 De Foigny, T r a i t s pratique de 1'inoculation. Extract in. Journal Encyclbpedique IX (1768) , p.72. 40 De Baux, P a r a l l e l e de l a petite verole 7).t/r. naturelie avec 1 ' a r t i f i c i e l l e ou inocul6e. Extract i n Mercure de France VII (1960), v . l , p.1/2. Tissot, p.275 . 55 . La Condamine., "Suite de l 1 h i s t o i r e de 1'inoculation de l a p e t i t e verole, depuis 1758 jusgu'en 1765. Troisieme Memoire," Hi s t o i r e de 1'Academie Royale  des Sciences, (Paris, 1765), p.513, wrote: "Celle de M. Gatti montoit a. pres de cent personnes en 176 3: e l l e approche aujourd'hui de deux cents." 4 3 " E x t r a i t d 1une l e t t r e du 25 A v r i l 1769," Jour na 1 E n c y c 1 OP e d icr ue VI, (1769) , pp.287-88, the anony-mous writer stated: "De 122 qui ont subi 1'operation, 112 ont p r i s l a malade qui n'a eu aucune suite facheuse. Tous se portent, pour le moins, aussi bien qu'auparavant. Les autres dix n'ont point p r i s l a p e t i t e verole, quoiqu 1 inocules plusieurs f o i s ; i l est probable q u ' i l s l'ont eue dans leur tendre enfance & plusieurs en portent des marques...Les p e t i t s murmures contre l a commission dont e t o i t charge l e Dr. Gatti se sont convertis en benedictions, & plus de 40 habitans de cette p e t i t e v i l l e se sont f a i t s inoculer par differens Chirurgiens i n s t r u i t s par M. G a t t i . . . . La fureur pour 1 1 inoculation redouble; on vient d 1 i n o c u l e r plus de 5 0 enfans du peuple dans l a v i l l e meme." 44 Grimm, Correspondance VIII, p.321. 45 Duboueix, "Histoire de 1'etablissement & des succes de 1 1 inoculation dans l a v i l l e de Nantes," Journal  Encyclopedique I I I , (1774), pp. 494-95. Goubert, Malades et Medecins p. 325. Chapter II RESISTANCE TO THE INTRODUCTION OF INOCULATION AGAINST SMALLPOX Although the practice of inoculation against small-pox had been introduced into medical and court c i r c l e s i n England, the interest, i n inoculation continued to face stubborn opposition between the years 1722-1734 i n France. As we have seen, there had c e r t a i n l y been a r e l a t i v e l y ex-tensive body of r e l i a b l e information, for not only were the medical accounts of Timoni and P y l a r i n i available to learned c i r c l e s , but the Newgate experiment (1731) and the i n i t i a l royal inoculations were reported to France i n de-tail."^" Hence, th i s chapter i s divided into three main themes. The f i r s t deals with the propaganda warfare used by the court doctors to introduce inoculation; the second treats the period when the technique came to the medical p r a c t i t i o n e r ' s attention and how i t was r e s i s t e d as a legitimate branch of professional medical pra c t i c e ; and the t h i r d i s concerned with the contemporary viewpoint that saw the practice as interference with God's w i l l , as a means of spreading natural smallpox among healthy people, and as an i n e f f e c t i v e prophylaxsis against smallpox During the course of the eighteenth century, a re-l a t i v e l y new and growing section of the medical pro-fession under the patronage of the king - the court doctors - put forward demands for the reform of the medical guilds, for changes i n law r e l a t i n g to medical practice, 2 and the reform of medical education. As part of the movement for medical reform, the struggle to introduce the practice of inoculation can be seen as an important campaign i n the s o c i a l o r i g i n s of changes i n the structure 3 of the profession. Indeed, t h i s minority group provides an important clue to an understanding of the struggle for reform of the Paris Faculty of Medicine i n the eighteenth century. As for the i n s t i t u t i o n a l structure of the medical profession during t h i s period, the c o n t r o l l i n g body for doctors was the Paris Faculty of Medicine. For centuries the Paris Faculty had formulated and monopolized the decision-making functions over medical a f f a i r s i n Paris. Holding firm the notion of i t s authority to i n s t r u c t and sanction licenses from c l e r i c a l rather than royal p r i v i l e g e , i t had during the course of i t s development become an ex-clusive medical corps and p r i n c i p a l judge i n key issues re-4 l a t i n g to public health. Indeed, i t was an e l i t e professional corps founded on a good reputation and a s o l i d network of acquaintances which constituted a p r i v i l e g e d path to wealth and prestige. Comprised of 88 doctors i n 172 0 and granting admission to two students per annum, the Paris Faculty was held together by a common body of knowledge expressing a t r a d i t i o n a l and dogmatic p o s i t i o n . Its approach seemed to derive from assiduous observation and r i g i d adherence to ancient custom, modes of thought 5 and r a t i o n a l i z a t i o n . In order to maintain the high status and standards which doctors had long enjoyed, the Paris Faculty tended to generate skepticism and ambivalence toward any medical a f f a i r s which were l e g a l l y issued from other governing bodies, namely, the Crown. I t has been noted that the Paris Faculty was not considered to be an opponent of progress per se, but only tolerated that pro-gress which came from i t s own rank-and-file. Perhaps thi s explains, to some extent, the reputation accorded i t of consistently r e s i s t i n g novel medical ideas and practices For example, the Paris Faculty opposed Harvey's doctrine of the c i r c u l a t i o n of the blood, and i n c l u s i o n of antimony under the rubric of approved drugs, and the e f f i c a c y of Peruvian bark during the course of the seventeenth century. It i s also well-known that the medical corps of the Paris Faculty became so preoccupied with monopolizing the huge f i e l d of health that they employed l e g a l methods by which they could refuse to examine candidates for i t s license i n any branches of practice t r a d i t i o n a l l y held to be within g the sphere of the Paris Faculty p r a c t i t i o n e r . The structure of the profession, however, was altered by the emergence of a new type of p r a c t i t i o n e r - the court 59. doctor - who cut across the professional d i v i s i o n s which were enshrined not only i n the l e g a l system, but also i n the i n s t i t u t i o n a l structure of the profession as a whole. The development of the c o n f l i c t appeared to derive from the attempt of Louis XIV to consolidate the medical a f f a i r s of France under royal d i r e c t i o n and control by means of circumventing the power of the Paris Faculty through the 9 agency of his personal medical corps. In e f f e c t , a r i v a l medical corps was established to challenge t r a d i t i o n a l authority of the Paris Faculty. Yet i t must be remembered that the court doctors were not a university g u i l d . They had no formal teaching functions; they offered no courses; and they granted no degrees. For the court doctors medicine was an open a c t i v i t y never to be r e s t r i c t e d to a group of i n i t i a t e s . Moreover, they were recruited d i r e c t l y by the king not on the p r i n c i p l e of any formal c r i t e r i o n of e l i g i b i l i t y but on the basis of demonstrated competence alone. Indeed, i t was t h i s idea of demonstrated competence that was the key to t h e i r understanding of t h e i r r o l e . The court doctors were, f i r s t and foremost, a body of experts."*"^ Secondly, they were often graduates of u n i v e r s i t i e s other than Paris and constituted part of the upper echelon of the c o u r t . ^ Granted j u r i s d i c t i o n over the practice of medicine and pharmacy throughout the entire kingdom, p a r t i c u l a r l y i n the legal realm/ they obviously began to intrude upon the legitimation of the Paris Faculty's dominant po s i t i o n within the profession, and of t h e i r status within the learned community. For example, Paul Delaunay has noted 6 0 . how the Paris Faculty feared that the i n f l u x of court doctors would threaten to undermine t h e i r authority and lower th e i r status i n that of the profession as well as i n the general society: Ce docteur de Montpellier [the court doctor: Chirac] formait des projets etrangement dom-inateurs revant d'etre 'le chef de l a me\decine du Royaume,' le directeur et l'inspecteur general "des Etudes et receptions des medecins de toute les Scales du royaume en quality de surintendant des t r o i s corps de l a medecins et sur les Facult<§s dont les doyens eussent 6t6 ses lieutenants, en sornme, un pouvoir analogue a c e l u i du premier chirurgien; on d i s a i t meme, q u ' i l a l l a i t tenter de prendre pied a l a Faculte par l a creation d'une Academie de Medecine.12 In l i g h t of t h i s threat, the Paris Faculty reacted i n a manner t y p i c a l of the time by employing the t a c t i c of re-fusing to sanction licenses to medical p r a c t i t i o n e r s who 13 were not Paris graduates. I t should be apparent that the court doctors did not f i t c l o s e l y with the t r a d i t i o n a l model of the doctor, and i t i s not surprising that they should be d i s s a t i s f i e d with a Faculty which was dedicated to maintaining the absolute control of medical practice and health-related problems i n Paris. I t must be emphasized that the problem of the re-lationship between the Paris Faculty and the court doctors was not simply an abstract debate about the nature of medicine as a body of knowledge, for the profession as a whole was i n i t i a l l y linked to questions of status, both within the professional community and i n the general society. Indeed, the struggle between the Paris Faculty and the court doctors during the eighteenth century can be seen as a r e a l c o n f l i c t of i n t e r e s t on a s o c i a l s t r u c t u r a l l e v e l . II In 1722 the court doctor Claude-Jean Baptiste Dodart, son of the celebrated n a t u r a l i s t and academician Dennis Dodart, prepared the ground for the discussion of inoculation i n France. Interested i n following the English model based on the successful inoculations of the English princesses i n 1722, Amelia and Carolina, Dodart appears to have been the f i r s t i n d i v i d u a l to contemplate measures for the i n t r o -duction of the practice into France - at least i f La 14 Condamine1s account i s to be accepted. F u l l y aware that i t s basic precepts c o n f l i c t e d with the moral and philoso-p h i c a l values of the e c c l e s i a s t i c a l a u t h o r i t i e s , he con-sulted i n that same year with the Jesuit Cardinal Andre Hercule Fleury on the r e l i g i o u s and c i v i l l e g a l i t y of inoculation. Shortly thereafter, Fleury proclaimed his support for the practice and i n turn proceeded to per-suade the Regent, the Due d'Orleans, to sanction experi-15 mentation i n order to evaluate the r i s k s of inoculation. Resolved to obtain expert medical judgement, Dodart then consulted with Jean Delacoste, a recently repatriated French r e l i g i o u s e x i l e and doctor who had studied with Boerhaave at Leyden and had witnessed the practice i n 16 England. Although he obtained medical t r a i n i n g at Leyden (1701) and published i n London i n 1715 an English 17 tra n s l a t i o n of Boerhaave 1s c l a s s i c work, Aphorisms, very l i t t l e further information on his personal experiences 18 i s available i n the l i t e r a t u r e . Delacoste, however, was a central figure in the f r u i t l e s s attempt to introduce inoculation into France during t h i s period, as we s h a l l now see. At the request of Dodart, who was c o l l e c t i n g informa-tion and data on the method of inoculation and i t s success i n England, Delacoste wrote to S i r Hans Sloane, the secretary of the Royal Society, d i r e c t l y on the question of the growth of the practice i n 1723. through what Motives the King of England has been pre v a i l d with to encourage that practice and i f you f i n d i t take among the people notwithstanding the arguments used against i t by several Physicians and Divines.19 This was a very important issue as i t determined whether or not London's medical and court c i r c l e s were well enough organized to spread the practice of inoculation as soon as the l o c a l demand for such protection developed. Using his position at court, Dodart had also discussed the practice of inoculation and i t s early successes i n England with Pierre Chirac, the f i r s t doctor to the Due d'Orleans, who also expressed his support for the medical 20 practice. Therefore, with encouragement from the Regent to introduce the practice, Dodart and Chirac proceeded i n 172 3 to a r t i c u l a t e t h e i r p osition before some clergy of.the Paris Faculty of Theology who opposed the practice on moral 63. and philosophical grounds. Delacoste, who drew up the .account of the controversy, summarized the clergy's position as follows: La Petite-Verole a r t i f i c i e l l e , disent les uns, n'est pas une v e r i t a b l e P e t i t e -V£role;.& suppose* qu'elle le s o i t , e l l e ne d o i t point rassurer:contre l'avenir. E l l e n'est que trop v e r i t a b l e , puisqu'elle a meme 6te* mortelle a plusieurs: d'ou i l s concluent que 1'Inoculation est i l l i c i t e & qu'on ne peut sans crime exposer n i enfans n i adultes aux suites d'un mai dont l a Providence les auroit peut-etre preservez.21 The orthodox r e l i g i o u s b e l i e f i n providence no doubt buttressed t h e i r attitude towards inoculation and the doctrine., that disease came from God. The l a t t e r could be interpreted-.:., to? mean that i t was impious to i n t e r -fere with God's w i l l by attempting to take conscious pre-caution against disease. This was, perhaps, one of the major i n i t i a l reasons why parents were reluctant to have th e i r children inoculated throughout most of the eighteenth century. The controversy, however-/ was abruptly halted when Parisian society encountered a severe epidemic of smallpox that same year. The serious outbreak of smallpox which occurred i n Paris a f f l i c t e d a considerable portion of the town-dwellers and caused widespread fear. Among the notable victims were the Comte de Nogent, the Marquis de Launaty, the Comte de Bissey and the Due d'Augmont. V o l t a i r e had witnessed the death of his f r i e n d Grenonville i n the 22 epidemic, and he himself had also contracted the disease. Moreover, i t led Delacoste to gravely t e l l his readers: Quelque exemple d 1 i n t r e p e d i t e que nous sonnent les Turcs & les Anglois sur ce qu'on appelle 1'Inoculation ou 1'Insertion de l a Petite verole; i l y aura en France une grande revolution a f a i r e dans les e s p r i t s , avant que de les rassurer contre les risques d'une p a r e i l l e operation... les repugnances de personnes timides ne sont pas neanmoins les seules oppositions q u ' i l a i t a combattre. I l se v o i t de p l a i n sur les bras. Les Docteurs en Medecine & les Docteurs en Medecine & les Docteurs en Theologie, qui tous ensemble attaquent l a methode de 1'Inoculation, les uns par les principes de leurs arts & les autres par ceux de Morale chretienne.23 The state of panic which smallpox must have engendered was used by the forces, d i r e c t l y or i n d i r e c t l y , opposed to the practice i n order to foster public resistance to inoculation. I t i s s i g n i f i c a n t to note that the fear of the epidemic served as one of the mechanisms that prohibited the i n t r o -duction of the practice into French society during the early eighteenth century. Areas where epidemics were infrequent, were l i k e l y to respond i n panic to the threat of an epidemic (as they did i n P a r i s ) , and perhaps th i s i s one of the most important factors i n determining the rate of spread of ino-culation i n d i f f e r e n t regions of France. On the other hand, the human response to an epidemic a f f l i c t i n g a large pro-portion of the population at just one point i n time led to a discussion of measures to conduct experimentation with inoculation. Hence, the timing of Delacoste's report on the progress of the practice i n England and against moral and medical superstitions which appeared i n 1723 i s of historical significance. This propaganda report contained strong evidence for the milder effects of inoculation and an abstract of Charles Maitland 1s Accounts (1721) . The l a t t e r i s described as follows: Ses recherches furent aussi heureuses qu'elles le pouvoient etre; on l'accabla d'experiences; on l u i produisit des Temeraires de toute espece; gens qui avoient eu l a curoisite* de subir une seconde fois 1'operation, ou que l'on avoit f a i t coucher avec d'autres infectez de l a Petite-Vdrole naturelle: l a methode de 1'Inoculation avoit triomphe par tout.24 Further on Delacoste provided s t a t i s t i c a l evidence from England to buttress his claim that the results of inocula-tion were less severe than natural smallpox: l.Q.ue la Petite-V^role naturelle y a 6t6 tres mortelle depuis No&l de 11ann£e 1722 jusqu'au 29.Juillet de 1'annee suivant. 2. Que l a Petite-Vdrole a r t i f i c i e l l e y a eu un succes merveilleux dans la meme espece de terns, quoique pratiquee sur plusieurs Adultes de 32.35.45.50. ans. Entre 1244 malades de la premiere espece de Petite Verole, l a l i s t e en compte 16 5 de morts; ce qui suit un sur huit & dix de plus & entre quatre-vingt de la seconde espece, elle n'en compte aucun, non seulement qui en soit mort, mais qui a i t eu d'autres Symptomes que ce qui paroit dans la Petite-V^role distincte & reguliere.25 There may have been a note of inaccuracy in some of his statements, but the overall emphasis on the s t a t i s t i c a l results of inoculation was almost certainly correct: inoculation reduced the risks of dying from smallpox. Unfortunately, this compelling work suffered, to some extent, because Delacoste did not provide an account of the method and technique, two es s e n t i a l features i n the propa- . ganda for the introduction of the practice into France. As a r e s u l t of Delacoste's propaganda work, a commission of nine prominent doctors of the Paris Faculty of Theology convened i n order to examine whether or not experiments with inoculation on criminals could be con-sidered l e g a l in France. In the seventeenth century similar legal decisions were required for experimentation with new drugs and s u r g i c a l techniques on condemned criminals. For example, Louis XIV authorized the elder Helvetius to ex-26 periment with ipecacuanha at Bicetre. Delacoste made a case for the introduction of the practice on the successful royal experiments at Newgate and he argued that i t was of 27 general benefit to mankind. Ostensibly, t h i s j u s t i f i c a t i o n supplied by Delacoste was acceptable to the majority for they decided to sanction by law experimentation with inoculation on condemned criminals and issued the following formal statement: "Qu'il £toit l i c i t e dans l a vue d'etre u t i l e au Public, de f a i r e ses experiences de cette 28 pratique r" The experiments, however, were never conducted despite the sanction of the Theology Faculty and the patronage of the court doctors. La Condamine was somewhat puzzled by t h i s , but ascribed the f a i l u r e to four key factors: Les bruits faussement rtpandus des mauvais succes de 1'Inoculation a Boston, pendant l'£t<§ de 1723, le nombre des morts que l'epidemie emporta cette meme annte a Londres, & que l'on mit faussement sur l e compte de 1'operation, quelques malheurs causes, qui commirent des exces, avoient diminue l a confiance publique. . . . l i s eussent £te" favorises par un prince (Monseigneur le Due d'Orleans, Regent de France, mort l e 3 Decembre 1723)...Mais a peine e u t - i l les yeux ferm£s qu'on soutint dans les 4coles de medecine un these (An Variolas inoculare nefas?) qui sonna le toscin contre les inoculateurs: on y t r a i t e leur operation de c r i m i n e l l e , ceux qui l a pratiquent d'imposteurs & de borreaux, & les patiens de dupes.29 Claude de La Vigne, the doctor who defended the medical thesis An Variolas inoculare nefas?, viewed the s p i r i t of novelty as dangerous i n medicine as well as i n r e l i g i o n . Although new philosophical systems could be created i n regard to the inanimate universe, they were extremely dangerous i n dealing with human l i f e , and he had to con-clude that, C'est usurper les" d r o i t s de l a : • . • d i v i n i t y , que de donner une maladie a c e l u i qui ne l ' a pas, ou d'entreprendre d'y soustraire c e l u i qui dans 1' ordre de l a providence y 6 t o i t naturellement destine.30 Perhaps, the formal r e l i g i o u s argument mirrored a growing popular prejudice against inoculation as La Vigne noted: v L'Inoculation est un rnal moral: en v o i c i l a preuve. On ne peut nier q u ' i l ne s o i t mort quelques inocules; le succes de cette methode n'est done pas i n f a i l l i b l e : on ne peut done s'y soumettre sans exposer sa vie, done i l n'est pas permis de disposer: 1'inoculation blesse done les principes de l a morale.31 More importantly, there was the argument against inoculation on medical grounds. La Vigne pointed out the great p o s s i b i l i t i e s of inoculation spreading the smallpox 68 . contagion: En e f f e t l a contagion se repand par c e l u i qui r e c o i t l a p e t i t e Verole, par c e l u i qui l ' i n s e r e , par c e l u i qui apporte l e Pus; e l l e se repand encore plus univer-sellement par ceux qui ayant apres 1'Inoculation des ulceres sortent en-core convalescens, & vont a i n s i porter dans les rues & chez leurs amis le poison dont i l s ne sont pas encore delivres.3 2 We must allow for some exaggeration i n t h i s account, as i t was written by someone concerned with d i s c r e d i t i n g ino-culation, but i t probably contains a substance of truth about inoculated cases as a source of contagion and c l e a r l y i l l u s t r a t e s the lack of concern of many contemporaries to provision of i s o l a t i o n of patients from other members of the commumity who had not contracted smallpox. Indeed, as we s h a l l see l a t e r , a key factor checking the practice of inoculation was the fear that i t would spread smallpox to unprotected segments of a community. This invariably led to a p r o h i b i t i o n of the p r a c t i c e . I t i s highly probable that town authorities were frightened by the f a c t that, i f inoculation were practiced, i t would spread the disease to unprotected people. Another important factor i n the early opposition to inoculation was that Delacoste himself held no s i g n i f i c a n t rank within the medical community. Despite the f a c t that Delacoste had obtained formal medical tr a i n i n g , La Vigne contempuously referred to him as an "empiric" who had come to seek the favors of fortune and an asylum i n France, which did l i t t l e to case a favorable l i g h t even among 33 sympathetic medical p r a c t i t i o n e r s . I t must be pointed out that La Vigne employed the term "empiric" to d i s c r e d i t Delacoste among the rank-and-file p r a c t i t i o n e r s . And, i n the context of the early eighteenth century, the attempt of a doctor or surgeon to apply a remedy to an i l l n e s s which at the time had no medical foundation usually prepared the way for professional c r i t i c i s m and action by means of withholding patronage and establishing a le g a l 34 monopoly through the enactment of l i c e n c i n g laws. In June 1723 Sloane published a l e t t e r i n Philosophical Transactions that he had received from Delacoste, revealing Delacoste as an opportunist who had notions of securing a patent for the practice i n France: In short, S r, This i s an oportunity >: •': of making myself known to ye Publick and agreable to the man who has i t d a i l y i n his power to serve me.35 Further on he added: This i s therefore to begg of you to hasten as much as possible the favour I desird i n my Last v i z : to acq.t me with the hist o r y and progress and method of i t i n England, not only to his [Dodart's] S a t i s f a c t i o n but to serve me as a guide i n this a f f a i r which i n a l l l i k e l i h o o d w i l l prove of great advantage to me. I have great pros-pect that I s h a l l obtain a patent for that practice, i f the Experiments prove s a t i s -factory and i f y r account gives hope of Success i n the Main.36 To some extent, t h i s i l l u s t r a t e d his motives for attempting to introduce the medical practice into France. Although medical patents might not have been discre d i t e d arid doctors did indeed apply secret "folk" remedies to cure i l l n e s s , the attempt to keep the method a secret i n order to secure the exclusive rights for a luc r a t i v e new medical practice would not have been encouraged or tolerated by his contemporaries. In France, the attempt to monopolize inoculation by means of patent rights never took place again throughout the eighteenth century. The most notorious opposition came from the formidable •': Philippe Hecquet, a senior medical p r a c t i t i o n e r of the Paris Faculty and erstwhile Dean, who acquired a reputation for h i s conventional views on 37 medicxne xn the eighteenth century . For instance, he had objected to the application of chemical remedies to i l l n e s s e s and the ways i n which many drugs or surgical techniques reached the public from the hands of i l l -trained and adventurous "empirics." He believed that bloodletting was the primary therapeutic agent, for which he was s a t i r i z e d as the pedantic, verbose Dr. Sangrado i n 38 Le Sage's G i l Bras. Hecquet advanced a program for sound medicine which emphasized nature rather than books, and t r a d i t i o n rather than close observation as a guide for treating the causes of i l l n e s s and disease. In thi s • respect, he f e l t that the introduction of novel medical ideas, instruments, techniques.and procedures departed 39 from the basic precepts of nature. Therefore, Hecquet set forth the code of nature and i t s r e l a t i o n to man i n his essay e n t i t l e d : Raisons de doute contre 1'inoculation which demonstrated that modern medicine could not contravene .natural laws that God had established. In fact, he confessed h i s b e l i e f that " l a medecine est l ' a r t de penser. sur l a sante des hommes, l a science de 40 mediter sur leur conservation." In addition, Hecquet attempted to refute the practice of inoculation d i r e c t l y with the conviction that nature possesses a natural wisdom which cares for mankind: Entre les mains de l a nature c ' d t o i t un ouvrage de sagesse; dans c e l l e s de l ' a r t c'est une oeuvre du hazard, une enterprise d'avanture; parce qu' enfin un miserable emetique brusquement donne, o u quelque evacuation de cette espece aussi mai entendue renferme toute l a precaution qu'on apporte pour se preparer a 1'Inoculation.41 Further on he concluded that inoculation was contraire aux vues du Createur, car qu'ainsi ne s o i t qu'on donne a 1'homme des maladies qui n' auroient point ete prevues dans l a creation de son corps, ce s e r o i t f a i r e ce qui n'auroit point ete dans les vues ou les arrangemens de l a providence.42 This was of primary importance for when Hecquet stressed the dependence of medicine on God and pleaded for the recognition of divine power, he was r e f l e c t i n g the major concern of his period, namely, a t r a d i t i o n a l r e l i g i o u s attitude toward i l l n e s s and disease. In the l a t e 1720s and early 1730s, a li m i t e d number of learned.men campaigned on behalf of inoculation against smallpox. For example, La Condamine reported his personal observations i n Constantinople to the Academie des Sciences i n 1732 as follows: L'inoculation de l a p e t i t e verole est, comme on s c a i t , usitee depuis long-temps en Levant; c'est meme de-la qu'elle a passe en . Angle terre... Cette operation est aujourd'hui non-seulement. pratiquee par les sujets du Grand-Seigneur; mais un grand nombre de Francs de toutes les Nations d'Europe e t a b l i s a Constantinople, & qui y ont epouse des Grecques, se. sont conformes sur ce point a l a mode du Pal's, sont tous les jours i n -serer l a p e t i t e verole a leurs enfans & se trouve'nt bien de cet usage.43 With the appearance of V o l t a i r e ' s LettresPhilo soph iques published i n 17 34 - a work i n which his English observations and Anglophile background were made to serve, d i r e c t l y and i n d i r e c t l y , as a means to attack the structure of French society - h i s eleventh chapter e n t i t l e d "Sur 1'insertion de l a p e t i t e verole," stemming from his personal experience i n London (1726-1729), stressed the deliberate immunization 44 against smallpox and inveighed against quackery. Gustave Lanson's review of the propaganda l e t t e r , however, points out that i t was highly sentimental i n con-tent. For example, there seems to be no sound basis for the story popularized by V o l t a i r e that inoculation had been invented among Circassians because Les Circassians sont pauvres, & leurs f i l l e s sont b e l l e s , aussi ce sont e l l e s dont i l s font le plus de t r a f i c ; i l s fournissent de beautes les Harems du Grand Seigneur, du Sophi de Perse, & de ceux qui sont assez riches pour acheter et pour entretenir cette marchandise precieuse.45 By 1725, however, the adverse propaganda on inoculation had checked any e f f o r t s to introduce the practice into France. I t was looked upon with fear and suspicion by the French public as a whole, p a r t i c u l a r l y those l i v i n g i n P a r i s . According to contemporary perceptions, the reluctance was firmly grounded on three main points. The f i r s t was whether inoculation guaranteed immunization against small-pox or not; secondly, whether or not i t involved a lesser r i s k than the disease contracted i n a natural way; and t h i r d l y , the reluctance to introduce the practice of ino-culation into a community that was free from i t . As for the medical profession i t s e l f , i t was the schism between the court doctors and medical p r a c t i t i o n e r s of the Paris Faculty toward inoculation that checked the p r a c t i c e . Crustly, d o c t r i n a i r e , p r i v i l e g e d and exclusive, members of the Paris Faculty r e s i s t e d the i n f l u x of new ideas and programs with every means at t h e i r disposal. As the governing medical e l i t e , they held firm the notion that they were best suited to determine what was best i n the development of medicine. The employment of new tech-', niques used i n the operation was also r e s i s t e d by a medical corps f a r too engrossed i n attending to i t s proper function: namely, the sanctioning of licences to practice medicine i n France. To understand how the resistance to inoculation continued to spread and then began to slowly lose ground, and to see the extent of inoculation, we must turn to a consideration of the early practice of inoculation and examine the main reasons why i t did not become universally established i n France during the mid-eighteenth century. NOTES French learned p e r i o d i c a l s such as the J e s u i t Journal de Trevoux and the secular Journal des Savants provided lengthy reviews of some of the leading works published i n London as well as reports of the inoculations themselves. See Gustave Lanson, Lettres Philosophiques, I, new e d i t i o n by Andre Rousseau (Paris, 1964) , pp.137-38; Jacqueline de La Harpe, "Le Journal des Savants et l'Angleterre 1702-1789," University of C a l i f o r n i a Publica-tions i n Modern Philology XX (1941), 6, p.315. 2 For a discussion on the role of the court doctors i n French society to the movement for medical re-form, see Guy Chaussinand-Nogaret, "Nobles medecins et medecins de cour au XVIII e s i e c l e , " Annales E.S.C. XXXII, pp.851-57; see also J.P. Peter, "Les mots et les objets de l a maladie. Remarques sur les epidemies et l a medecine dans le societe francaise a l a f i n au XVIIie S i e c l e , " Revue historique 246 (1971), pp.13-38; Idem, "Disease'and the Sick at the End of the Eighteenth Century," trans. E. Forster i n Biology of Man i n History, R. Forster and 0. Ranum eds., (Baltimore, 1975), pp.81-124; and C. Hanna-way, "The Societe Royale de Medecine and Epidemics i n the Ancien Regime," B u l l e t i n of the History of Medicine, XLVI (1972) , pp.257-73. 3 This point i s also made by Nogaret, p.851. 4 Unlike the other f a c u l t i e s of the University of Paris, the Faculty of Medicine was not only a teaching corps, but also supervised medical-police measures, drug inspection, the water supply, medical-legal questions and the adulteration of basic foodstuffs. For a l i m i t e d discussion on t h i s point, see Paul Delaunay, Le Monde  medical p a r i s i e n au XVIII e s i e c l e (Paris, 1906), pp.38-39 . 5 See M. Bariety and C. Coury, H i s t o i r e de l a  medecine (Paris, 1963), pp.483-84, who noted: "On v i t des e s p r i t s - souvent b r i l l a n t s d' a i l l e u r s - se retrancher centre toute evidence - derriere l e rempart des vieux dogmes et defendre farouchement par tous les moyens dont l a mauvaises f o i n ' e t a i t pas exclue, des notions perimees." See also, Delaunay, p. 37, and C. Coury, L'Enseignement de l a medecine en France (Paris, 1968), pp.21-26. 75. Bariety and Coury, pp.483-84; Delaunay, passim. 7 For a f u l l e r discussion on t h i s topic, see Bariety & Coury, pp.487-505, 553-54; and F. Lebrun, Les  Homines et l a mort en Anjou au 17 e et 18 e s i e c l e s (Paris, 1971), pp.281-85. 8 For a discussion on the i n s t i t u t i o n and s t a f f , and i t s medical philosophy, see C. Coury, pp. 39-83; Bariety and Coury, "Les Siecles de Raison," passim; M. Foucault, The B i r t h of the C l i n i c trans. A.M. Sheridan Smith (New York, 1973), pp.58-61; and Delaunay, pp.1-93. 9 Nogaret, pp. 851-53. 1 0Nogaret, p. 856, wrote: "Par les b i a i s de 1'anoblissement qui f a i t au XVIII e s i e c l e la,plus b e l l e part au merite personnel, par c e l u i des charges de cour largement ouvertes a l a renommee et au talen t , l e medecin du XVTII e sifecle peut esperer se hisser au premier rang des e l i t e s reconnues, nonobstant son defaut de richesse, par l a seule vertu de son zele, de son savoir, de ses services." For a s i m i l a r discussion, see J . Meyer, "L' enquete de 1'Academie de medecine sur les epidemies, 1774-1794," Etudes rurales no.34, 1969, pp.7-69; and J.P. Goubert, Malades et Medecins en Bretagne, 1770-1790 (Paris, 1974), pp.127-181. U S e e Nogaret, p.854, who stated:"Au XVIII s s i e c l e les medecins de cour forment une e l i t e e t r o i t e re-crutee parmi les meilleurs s p e c i a l i s t e s de l'epoque. "16 d'entre eux furent anoblis et quelques-uns parvinrent a une grande fortune." 12 Delaunay, p. 117. 13 Ibid., p.117. 14 La Condamine's memoirs are one of the primary sources for the early h i s t o r y of inoculation i n France. For a l i m i t e d discussion on Dodart see La Condamine, "Memoire sur 1'inoculation de l a p e t i t e verole," H i s t o i r e  de 1'Academie Royale des Sciences (Paris, 1754), pp.618-19. 1 5 I b i d . , p.620. 16 Ibid., pp.621-22. See also La Condamine, "Second Memoire sur 1' inoculation de l a pe t i te .verole, con-tenant l a suite d ' h i s t o i r e de cette methode & de ses progres de 1754 & 1758," i b i d . , p.444. 76. 17 Boerhaave's Aphorisms:concerning the knowledge and Cure of Diseases. Translated from the l a s t e d i tion printed i n L a t i n at Leyden, 1715. With useful observations and explanations, by J . Delacoste M.D. (London, 1715) . Cited i n Lanson, p.140. This work had popularized the medical, view that a mixture of mercury and antimony produced a long-sought remedy against the "poison" which caused smallpox which, i n turn, became the rationale for the use of these substances as pre-paratory medicines. 18 I t has been suggested, however, that Delacoste served as the agent to spread r e l i a b l e medical information when he forwarded J.C.A. Helvetius, the physiologist, and f i r s t doctor to the Queen, l a t e s t work, Idee generale de l'odconomie animale et observations sur l a p e t i t e verole, that stressed the c l a s s i c a l humoral theory, to the Royal Society i n 1722. See Genevieve M i l l e r , The Adoption of Inoculation for Smallpox i n England arid France (Philadelphia, 1957)1, pp. 182-83. 19 "A Letter from Delacoste to S i r Hans Sloane, Barr. C o l l . Med. Lon., concerning the Inoculation of the Small-Pox," Philosophical Transactions, XXXII (1723), p.315. 20 Fontenelle, "Eloge de Chirac," Oeuvres VII (Paris, 1792), pp. 419-34. 21 Delacoste, Lettres sur 1'inoculation de l a  p e t i t e verole comme e l l e se pratique en Turquie et en  Angleterre. Extract i n Journal de Trevoux, XXIV, (1724) , p.1078. 22 Lanson, p.148. 2 3 Delacoste, p.1073. 2 4 I b i d . , p.1077. 2 5 I b i d . , p.1085 . 2 6 Ba r i t t y and Coury, p.554 . 2 7Delacoste, p.1085 28 La Condamine, "Memoire," p.621. 29 Ibid., pp.621-22. 30 Ibid., p.641. For a detailed discussion on La Vigne's. thesis "An variolas inoculare nefas? See La Condamine, "Memoire," pp.634-50. 3 1 I b i d . , p.647. 3 2 I b i d . , p.647. 3 3 I b i d . , p.648. 34 See the discussion on the term "empiric" i n the introduction and i n chapter one. 35„ p.317. A Letter from Delacoste to S i r Hans Sloane," 3 6 I b i d . , p.317. 37 Delaunay, pp.208-17, passim. 3 8 I b i d . , pp.208-09 . 39 Bariety and Coury, p.59 0. 40 Avis sur le dessem de ce p e t i t ouvrage. Preliminary note. "^Hecquet, Observations sur l a saignee du pied  e t sur l a purgation au commencement de l a petite verole, des fievres malignes & des malades. Preuves de decadence  dans l a pratique de medecine, confirmees par des justes  raisons de doute centre 1'inoculation (Paris, 1724), pp .418-18. 4 2 I b i d . , p.415 . 4 3 L a Condamine,"Observations Mathematiques et Physiques. Faites dans un voyage de Levant en 1731: &•'1732," Hi s t o i r e de 1' Academie des Sciences. "(Paris, 1732), p.316 Lanson, pp.130-151. 4 5 - I b i d . , p.131. Chapter III THE EARLY PRACTICE OF INOCULATION AND ISSUES IN ITS SLOW GROWTH In A p r i l 1721, as we have seen, Lady Montagu had her daughter inoculated i n London, and from'this date on-wards inoculation came into fashion among the aristocracy and gentry, p a r t i c u l a r l y a f t e r the court had witnessed the inoculation of two royal members Amelia and Caroline i n A p r i l 1722. According to the inoculation censuses conducted by J u r i n and Scheuchzer during the 1720s, there were 89 7 inoculations i n England during the years 1721-28.^ After 1728 no attempt was made to count the number of inoculations, which led La Condamine to con-clude that On les entend dire froidement & avec ingenuite qu'aujourd'hui cette methode est abandonnee en Angleterre, tandis qu'elle n'y fut jamais plus a c c r e d i t e d This conclusion has been confirmed by Genevieve M i l l e r who has argued that at no time did inoculation cease to be practiced, and c i t e d the examples of inoculations taking place i n Haverfordwest, Pembrokeshire i n 1732, i n Bury and Dumfries, Scotland during 1733, and i n I r e -3 land i n 1734. However, she also pointed out that "the number of publications on the subject declined, so that during the 1730s one finds only a few pamphlets and 4 occasional journal a r t i c l e s . " This hiatus i n information coincided with an apparent numerical decline of publications on ino-culation by English writers i n French learned p e r i o d i -5 cals during the 1730s and 1740s. And i t was not u n t i l 1759 when the secular Journal des Savants said: "Aujourd' hui nous pensons que tout ce qui vient des savants anglais est superieur a ce que nous possedons..."^ that the editor of the journal, Berthier, decided to increase the 7 . number of English medical reviews. In addition, the decline of inoculation was noted approvingly by La Mettrie the former d i s c i p l e of Boerhaave who p e r s i s t e n t l y alluded to the "great art of healing" as man's noblest a c t i v i t y i n L'Homme Machine - who argued i n a t r e a t i s e on smallpox published i n 1740 that "II est done evident que cette pratique est en soi pernicieuse, & que les Anglois ont g f a i t sagement de 1' abandonne"e . Whatever the changes i n the extent of inoculation and the number of journal a r t i c l e s during the 1730s and 1740s, contemporaries were unanimous on the in s i g n i f i c a n c e of the practice at any time during t h i s period. Apart from the severe epidemic which struck the people i n Paris (1723), France i n general encountered only a few i s o l a t e d ones such as i n Lodeve i n 1736, Marseilles i n 1741, and Montpellier i n 1744 and 1745, but there was no general pandemic. Despite the fact that France lacked r e l i a b l e s t a t i s t i c a l studies l i k e those of the London B i l l s of Mortality - to demonstrate how the outbreaks of smallpox caused the death-rate to exceed the b i r t h - r a t e - i t may have been due to the r e l a t i v e l y low annual death t o l l s from smallpox. Hence, a p r i o r i one may believe that the population as a whole did not show an i n t e r e s t i n the practice because they were not alarmed by i t as a great danger. Since the fear of contracting natural smallpox was not considered to be as serious as the p o s s i b i l i t y of contracting i t from inoculation, i t was not necessary to advance the pr a c t i c e . The psychology of thi s attitude i s not d i f f i c u l t to understand, for a remote r i s k , however dangerous, i s often preferable to an immediate one. For example, th i s point was noted by D'Alembert i n 1760 when attempting to explain why inoculation was not gaining ground: Si 1'inoculation peut f a i r e perdre l a vie , et en meme temps e l l e preserve de l a p etite verole n a t u r e l l e , le p a r t i que doit prendre tout homme sage est de ne donner de conseil a personne ni pour n i contre cette operation...le reste de crainte q u ' i l peut toujours avoir, de donner par 1 1 inoculation une mort pre-maturee a quelqu'un des ses enfans, et peut-etre a c e l u i qui l u i est le plus cher, ne peut pas avoir assez de force pour l e f a i r e balancer.10 Such an attitude could f l o u r i s h only where there was a known r i s k of dying from inoculation, and the practice of inoculation was s t i l l considered to be f a i r l y dangerous during the period under discussion. Another important factor i n the early r e j e c t i o n of inoculation was the stubborn opposition to the absorption of new English i n t e l l e c t u a l ideas. La Condamine wrote i n 1754: Cette pratique est presque inconnu en France... Ce n'est pas le seul exemple qui prouve combien le Public est mal i n s t r u i t en France des nouveautes u t i l e s au progres des sciences & des arts, & meme au bien de l'humanite, quand e l l e s prennent naissance hors du royaume. x ± Perhaps, the widespread resistance to inoculation was only a symptom of the underlying f e a r f u l defensiveness against a l l new foreign ideas. The most e f f e c t i v e offensive against t r a d i t i o n a l modes of thought and action i n eighteenth century France was firmly grounded i n the program of the philosophe movement. For the observant philosophies, the p o s s i b i l i t i e s of an Enlightenment manifested themselves not so much i n the r i s e of the natural sciences such as Newtonian physics and astronomy, but i n the achievements of medicine. The Encycloptdie, the most important enterprise of the philosophes, popularizing l i t e r a r y , h i s t o r i c a l and " s c i e n t i -f i c " information, e n l i s t e d a corps of natural s c i e n t i s t s , academicians and medical men such as the n a t u r a l i s t Daubenton, the botanist Le Monnier and Quesnay, by pro-fession a surgeon and founder of physiocracy, to spread r e l i a b l e new knowledge of immediate p r a c t i c a l concern to French society as a whole. 82. As a r e s u l t of t h i s new program, the f i r s t important change i n the fortunes of inoculation took place on 14 A p r i l 1754 at a public meeting of the Academie des Sciences when La Condamine read his "Memoire sur 1'inoculation de l a p e t i t e verole," and therefore launched his campaign on 12 behalf of inoculation against smallpox. Carefu l l y documented on the basis of extensive reading, i t was c l e a r l y the work of long r e f l e c t i o n and not of sudden im-13 ' pulse. La Condamine took a very strong position and, after r e c a l l i n g the misfortunes caused by smallpox made his attitude clear i n these introductory and challenging remarks: L' inoculation, pr^servait sur, avoue* par l a raison, confirm^ par 1 1 experience, permis, autorise* meme par l a r e l i g i o n , s'offre a nous pour arreter le cours de tant de maux & semble demander a l a pol i t i q u e d'etre mis a l a tete des moyens propres a conserver & a m u l t i p l i e r 1' espece humaine. Qui peut nous empecher de r e c u e l l i r les f r u i t s de ce b i e n f a i t de l a providence?14 The most important aspect of his memoir focused on the position taken by a n t i - i n o c u l a t i o n i s t s who believed that inoculation was morally wrong. They claimed, as we have already noted, that as i t sometimes caused death, i t meant del i b e r a t e l y and needlessly exposing one's l i f e . Since t h i s was considered to be an interference with God's w i l l , i t was one that was forbidden to r e l i g i o u s people. La Condamine did not question the sjimtement that on occasions death resulted from inoculation. Instead he chose to base 83. his discussion on s t a t i s t i c a l data obtained from ino-culators working i n d i f f e r e n t regions of England during the 1746 epidemic. These s t a t i s t i c s showed that the p r o b a b i l i t y of death from inoculation was one i n three hundred and 15 seventy-five. . But what, he asked, were the p r o b a b i l i t i e s for those who had not been inoculated? To f i n d an answer, he c i t e d the results obtained by Jurin who examined more than 900,00 B i l l s of Mortality i n London from 1667-1687 and from 1701-1722. After setting aside children who died before the age of four years, which was then con-sidered the e a r l i e s t age for children, J u r i n found that one person i n seven died from smallpox. On the basis of these figures, La Condamine argued that, En inoculant votre f i l s , contre t r o i s censsoixante-quinze evenemens heureux, i l en est un a redouter: en ne l'inoculant pas, i l y a plus d'un a parier contre sept que vous l e perdez. Ce dernier risque est cinquante f o i s plus grand que 1'autre: choisissez maintenant, & balancez encore s i vous l'osez.l"? Consequently, he appealed for i t s introduction into France. He exhorted the learned community as a whole, i t s s p i r i t u a l leaders and i t s magistrates to d i f f u s e knowledge of t h i s practice so as to insure i t s ready acceptance: C e s t done aux facultes de theologie & de medecine, e'est aux academies, e'est aux chefs de l a magistrature, aux savans, aux gens de l e t t r e s qu' i l appartient de bannir des scrupules fomentes par 1'ignorance, & de f a i r e s e n t i r au peuple 84: que son u t i l i t e propre, que l a charite chretienne, que l e bien de l ' E t a t , que l a conservation des hommes sont interesses a .1' etablissement de 1'Inoculation.18 His address caused a revolution, according to Baron Grimm, the German l i t e r a r y and s o c i a l observer, 19 who held the philosophe point of view. La Condamine renewed the i n t e r e s t i n inoculation which had been dormant for over t h i r t y years and, by his courage and authority, became the r a l l y i n g point of those who favored i t . At the same time, he c r y s t a l l i z e d opposition and became the target of a n t i - i n o c u l a t i o n i s t s who suddenly increased i n numbers. Immediate support for inoculation came, under-standably, from those who favored the d i f f u s i o n of new ideas, whether " s c i e n t i f i c " or p h i l o s o p h i c a l . Moreover, the Journal des Savants gave a favorable account of La Condamine's memoir, and claimed that, L'auteur a prevenu dans ce "Memoire" toutes les objections qu'on pouvait l u i f a i r e , & i l se sert de ses avantages avec tant d'esprit & d'_ Eloquence q u ' i l y a tout l i e u d'esperer que les personnes les plus opposees a. cette pratique, s i u t i l e au genre humain, se l a i s s e r o n t enfin entralner par l a force de ses raisons & ^chauffer par l'ardeur de son zele.20 Freron,in L'Ann^e L i t t e r a i r e , wrote of his work with great enthusiasm and included a recent a r t i c l e from the London Gazette: On s c a i t depuis long-temps que l'Angleterre a 6t6 l a premiere a secourer le jjoug du prejuge* contre 1'Inoculation de l a petite Verole. Mais, apres 1'opposition ge.h£rale 85. que cette methode a rencontree de l a part des F r a n c o i s , on a ete surpris d' apprendre que M. de l a Condamine, de 1'Academie Royale des Sciences, a i t eu le courage de s'en declarer 1'apolo-g i s t e . On a l u i c i avec a v i d i t e l a d i s s e r t a t i o n q u ' i l - a presentee sur ce sujet a 1'Acadelmie. On en a trouve toutes les raisons deduites avec beaucoup de s o l i d i t e , & les consequences t i r e e s avec beaucoup de justesse & de connoissance de matiere q u ' i l y traite.21 To t h i s array of compliments should be added the review of the "Memoire" published i n the Journal de Trevoux. His argument i n favor of inoculation, his r e f u t a t i o n of moral and medical objections to i t , a l l were accepted without question. The anonymous reviewer's only complaint was that he lacked the space to write adequately of the memoir: II faut supposer que nous ne representons pas l a centieme partie de ce q u ' i l vaut en lui-meme. Et en ceci nous ne faisons point d'eloge; nous rendons justice.22 By 1755, the "enlightened" segment of the medical profession began to make serious e f f o r t s to f a m i l i a r i z e doctors, surgeons and, to some extent, the urban poor with the benefits of inoculation. As we have seen, the medical profession i t s e l f had been o r i g i n a l l y divided over the subject of inoculation, but i n that same year, Ambroise Hosty, an I r i s h docteur-regent of the Paris Faculty, was dispatched across, the Channel i n order to study inocula-:' . . 2 3 t i o n . During his three month v i s i t in England, Hosty was p r i v i l e g e d to exchange views with the doctors and surgeons of the English court as well as others prominently en-gaged i n the practice or i t s p u b l i c i t y such as Kirkpatrick and Maty. Moreover, Hosty had witnessed 252 inocula-tions, both at the Inoculation and Foundling Hospitals and wrote: Des 252 personnes dont j ' a i s u i v i .'• 1'inoculation, deux seulement m'ont paru en danger; l'un^etoit l e f i l s du Major Jenningo...age de 3 ans & sa gouvernante a gee de 2 3 ans. 25 Hosty also pointed out the r a r i t y of secondary contagion from inoculation, an argument based on the grounds that inoculation would spread'to the unprotected population: Je ne trouve pas un seul exemple qu'une personne qui a i t eu l a p e t i t e verole bien caracterisee par 1'inoculation l ' a i t eue une seconde f o i s i ; cela est fonde sur plusieurs experiences reiterees & bien averes. 2^ Contemporaries, as we s h a l l see l a t e r , continued to strongly disagree about the incidence and the extent of the danger of secondary i n f e c t i o n at least u n t i l the late 1780s. There was also popular opposition to inoculation on medical grounds, though l i k e the b e l i e f i n the highly contagious nature of the operation, vi'twas -not always based on an objective foundation. Andrew Cantwell, a doctor of Irish' extraction who had taken a degree at Montpellier and s e t t l e d i n Paris i n 1735, published a 27 work in 1755 designed to d i s c r e d i t the p r a c t i c e . He stated that he had o r i g i n a l l y favored inoculation. In 1729 he f i r s t performed the operation clandestinely at Montpellier and then i n Avignon. During 1734-35 he claimed to have inoculated four patients successfully i n 87. 28 P a r i s . But he could no longer be resolved to inoculate his c l i e n t e l e and noted: Je me suis trouve en plusieurs occasions differentes & j ' a i appris d'un grand nombre de personnes plusieurs accidens funestes qui m'ont enfin ouvert le s yeux sur le danger d'une pratique qui m'avoit d'abord paru s i avantageuse.^9 As evidence, he c i t e d a number of cases at Montpellier, Ireland and from professors at the Paris Faculty of a secondary i n f e c t i o n among inoculated cases and he added "qu'on peut etre attaque plus d'une f o i s de l a p e t i t e 30 verole." Moreover, he could not r e f r a i n from claiming that measles and chicken-pox were i n e f f e c t l i g h t cases 31 of smallpox. This type of mistake occasionally occurred, e s p e c i a l l y because smallpox i n Paris did not return re-g u l a r l y every few years, and i t was therefore possible to confuse i n d i v i d u a l cases of smallpox with other diseases 32 such as measles and chicken-pox. The removal of checks on the spread of inoculation was, to a considerable extent, due to the reduction of mortality as a r e s u l t of the improvement of technique. The spread of the practice was r e l a t i v e l y rapid among the upper s o c i a l classes a f t e r L o u i s - P h i l l i p p e had his two children, the Due de Chartres and Mile, de Montpensier inoculated by Tronchin i n March 1756. The l a t t e r point i s i l l u s t r a t e d by accontemporary description of the e f f e c t of the successful Tronchin method: M. Tronchin est l'homme le plus a l a mode q u ' i l y a i t actuellement en France...Enfin, pour nous achever de peindre, nos marchandes de modes ont invente une c o i f f u r e qu'elles 88 . appellent bonnets a 1'inoculation, et des robes du matin pour les femmes, qu'elles ont nommes tronchines, parce M. Tronchin recommande aux femmes de se promener et de f a i r e de l 1 e x e r c i s e de matin; i l leur faut par consequent des tronchines pour etre habillees v i t e et commodement.33 In fact, the Tronchin method was the beginning of a quasi-popular practice of inoculation. Fashionable Parisians, comprised of t i t l e d n o b i l i t y and high-ranking government o f f i c i a l s eager to adopt a l i f e - s a v i n g technique sought out TronchinVs consultation and care. The Marquis de V i l l e r o i , the Comtesse de Forcalquier, and Turgot were among the famous c l i e n t e l e that he attended 34 to while i n Pa r i s . Moreover, the practice of inoculation was spreading throughout the provinces, p a r t i c u l a r l y i n large towns, which led La Condamine i n 175 8 to estimate that, On peut compter depuis quatre ans en France au moins deux cents personnes inocultes: l a moitie sont des adultes pour le danger de l a pe t i t e verole est plus grand que pour les enfans.35 Yet, i n order for the popular practice of inoculation to be possible, i t was necessary for the price of inoculation to be r a d i c a l l y reduced. Unfortunately, t h i s was not car r i e d out by the popular inoculators such as Tronchin and G a t t i . For the royal inoculations alone, Tronchin had procured, '"dix mille ecus argent comp tan t', outre des x 3fi boites d'or e t d ' a u t r e s bijoux." This i l l u s t r a t i o n of c l i e n t e l e fees was probably not untypical of the period. 89. Inoculation was so expensive at the time because of the period of preparation, the sometimes complicated pro-cedures of blood-letting and purging, as well as the special medicines prescribed by attendant medical men. Hence, the price of inoculation during the years 1756-1775 was too high for the great bulk of the population. And the r e l a t i v e l y high price of inoculation con-'. tinued to deter the r u r a l masses from undergoing the operation. For example, i n Brittany as l a t e as 1786, the subdelegate of Chateaubriant remarked: I l est impossible de se s e r v i r de 1'inoculation dans les campagnes et parmi le peuple qui n'a pas de commodites et les facultes suffisantes. C'est une operation qui n'est p r o f i t a b l e qu'aux riches et tout a. f a i t pre*judiciable aux autres.^7 But not a l l medical p r a c t i t i o n e r s were concerned about f i n a n c i a l success. In f a c t , one medical man was concerned about the neglect of the poor i n P a r i s , and he attempted to remedy t h i s s i t u a t i o n by formulating plans to set up a popular charitable i n s t i t u t i o n for inoculating the poor, as i s shown by an advertisement: which appeared i n L'Annee L i t t e r a i r e : C'est cette conviction q u i m'a engage a eiever un Hospice pour 1'inoculation, tant pour l ' u t i l i t e que l a surete publique. Je dis pour l ' u t i l i t e publique, parce qu'un grand nombre de Citoyens n'ont pas de maisons de campagne & que 1'Inoculation devient t res couteuse, l o r s q u ' i l s'agit de ^ d£p lace r tout un menage. Par f l 1 e.tab l i s seme nt de. eet Hospice,' on 1 se procure ra, mbyennant un pr i s e honnete, ce qu' on n'auroit obtenu qu'a grands f r a i s & avec beaucoup d'embarras. Plusieurs personnes ne peuvent q u i t t e r ". • leurs a f f a i r e s ou leur commerce pour suivre leur famille qui voudroit se soumettre a 1'Inoculation. A present, sans se deplacer & sans interrompre l e cours de leurs a f f a i r e s , l e s parens pourront mettre leurs enfans, dans cet Hospice, ou i l s jouiront de tous les egards qui leurs sont dus. Pour f a i r e v o i r que e'est le seul i n t e r e t public qui me touche, je l a i s s e chaque personne maitresse du prix qu' e l l e voudra donner.38 This appears, however, to have been an i s o l a t e d humani-tarian charitable gesture and plan to introduce d i f f e r e n t i a l prices according to the f i n a n c i a l circumstances of the patients during the period of discussion. When inoculation was introduced by medical p r a c t i -tioners i n France between 1754-1760, i t was not thought to be contagious to those who had already had smallpox. Tronchin from his experiences i n Geneva concluded that inoculation was not inf e c t i o u s i n the way that natural smallpox was, but he was soon to be challenged by a n t i -i n o c u l a t i o n i s t s f o r , according to Hosty, " i l s ont ete rt d u i t s par l'tvidence des f a i t s , a cette seule ob-jec t i o n , qu'elle ne garantit pas de l a pet i t e verole naturelle; aussi s'efforcerit :-ils def aire v a l o i r leur uniq 39 ressource." In 1756, Tronchin inoculated a young boy by the name of Delatour l i v i n g i n Paris; Gaullard,his uncle and medical p r a c t i t i o n e r i n Paris,concluded that, le jeune de l a Tour a eu une seconde petite verole v e r i t a b l e q u ' i l avoit done 4t€ inocult en pur & qu'ainsi 1'inoculation ne preserve pas de l a rechute.40 91. In fact, the argument was of primary importance to the French public i n general for i t suggested that secondary contagion did a r i s e i n France, and that inoculated small-pox was merely a variant of the natural form, and as we saw i n the f i r s t chapter, that the success of inoculation was due to the p o s s i b i l i t y of "managing" the disease as well as selecting a milder form of the virus with which to inoculate people. The contagiousness of Delatour's inoculation was questioned by the Due d'Orleans i n 1759 who, i n turn, sent a commission of four doctors from the Paris Faculty to report on t h i s key issue. The commission concluded: Que l e jeune de l a Tour avoit une maladie de l a peau, connue & distingu£e par l a pe t i t e verole, long-tems avant que ." 1'inoculation fut pratiqu£e en Europe, une E r u p t i o n c r y s t a l l i n e & serieuse qui se termine sans s u p p u r a t i o n . . . c e t t e maladie est entierement differente de l a p e t i t e verole .41 Although the Delatour incident^refuted the arguments d i r e c t l y on the question of secondary contagion, the de-bate over t h i s danger continued throughout the mid-century. An important issue retarding the spread of inoculation was the opposition due to r e l i g i o u s opinion. In 1757 an anonymous c r i t i c i n the J e s u i t Journal de Tre*voux, con-vinced that mankind was determined by the forces of nature over which i t had no power, noted the following moral ob-jections and rebuked the mathematical c a l c u l a t i o n gradually being formulated by the propagandists for inoculation: La vie sauvee a mil l e citoyens ne j u s t i f i e pas l e meutre d'un seul; on n'a pas d r o i t d'allonger leur trame, aux depens de l a c.'sienne; le mal de l'un ne se repare, ne s'expie point parle bien des autres. La Morale ne trouve pas son compte doivent pas 1 1 emporter sur l a d i s c i p l i n e des moeurs; les regies de l a Morale sont plus precieuses a l ' E t a t que les maximes se trouvent en opposition, ce sont les systemes de l a P o l i t i q u e , qui doivent plierrsdusV les l o i x de l a Morale.42 More important than formal r e l i g i o u s opposition or the common philosophical objection though was popular pre-judice against inoculation which, although couched i n re-li g i o u s terms, was i n e f f e c t a r e f l e c t i o n of emotional attitudes towards death, and the anxiety about incurring deliberate r i s k s for a future remote gain. The anonymous c r i t i c went on to conclude that, Donner a quelqu'un qui se porte bien, une maladie que probablement i l n'auroit jamais eue, une maladie f a c t i c e qui peut le tuer, e'est se j o u i r de l a vie des hommes; e'est f a i r e violence a l'ordre, a l'humanite; e'est entreprendre sur les dro i t s de l a Providence par un moyen i l l i c i t e & par une operation diabolique.43 Part l y as a r e s u l t of thi s prejudice, the f i r s t major step toward making the practice universal was checked. Opposition to inoculation on r e l i g i o u s grounds never e n t i r e l y disappeared at any time during the period under discussion; for instance,one anonymous writer stated i n 1763: En e f f e t , toute innovation, s o i t dans l a Religion, s o i t dans l a Medecine, est d'une dangereuse' consequence. Donner un mal cer-tain pour l e guerir par un remede pour le moins i n c e r t a i n , & qui peut entrainer des suites facheuses, ce systeme me parqit contraire au bons sens, a l'humanite, a R e l i g i o n . 4 4 However, r e l i g i o u s opposition was not strong enough, i n i t s e l f to retard the spread of inoculation throughout French society as a whole. During the course of the eighteenth century, learned men i n French society gradually formulated a mathematical doctrine, of what had so f a r been merely rules of l o g i c a l thought. This ascendancy of precise information i n numerical forms, which ultimately led to the development of the calculus of p r o b a b i l i t y , consisted b a s i c a l l y of an attempt to apply a certainty p r i n c i p l e to the inductive 45 method of reasoning. In the attempt to prove that ino-culation was i n f a c t grounded on probable truth, La Condamine pointed out: II n'est done plus question i c i de morale n i de theologie, c'est une a f f a i r e de ' c a l c u l : gardbns-nous de f a i r e un cas de conscience d'un probleme d'arithmetique. 4^ Furthermore, the partisans of inoculation believed that facts, reasoning and a systematic inquiry 'into, mathematical c a l c u l a t i o n would be the most cogent proof for accepting r the practice and that i t would counterbalance r e l i g i o u s 47 opposition. Hence, they sought to prove s t a t i s t i c a l l y that inoculation did protect people.,,It was not by accident that the s t a t i s t i c a l method was applied to medicine during t h i s period since a growing number of learned men within the Academie des Sciences believed that inoculation was capable of mathematical abstraction and manipulation as evidenced by the a c t i v i t i e s of the mathematicians and academicians: La Condamine, Daniel Be r n o u l l i and D'Alembert - who played a key role i n i t s controversy and development. In reply to La Condamine's enlightening question: Who runs a greater r i s k of death, a healthy i n d i v i d u a l who waits for smallpox to seize him, or one who prevents i t by being inoculated? Daniel B e r n o u l l i , a foreign associate of the Academie, stated i n 1760: E l l e n 1appartient, comme le v o i t , ni a l a Medecine n i a l a Theologie, C'est une question de f a i t , mais compliquee, & qui ne peut etre resolue que par l a comparison d'un grand nombre de f a i t s & d'experiences, d'ou l'on puisse t i r e r l a mesure de l a plus grande pro-b a b i l i t y . Le risque de c e l u i qui attend l a p e t ite verole est en raison compose du risque d'avoir un jour cette maladie, & du risque d'en mourir s ' i l en est attaque. Le risque tout compose qu' i l est appreciable, & sa determination depend du c a l c u l des p r o b a b i l i t i e s , qui, comme on f a i t , est une des branches de l a Ge'ometre.4 8 Consequently, Be r n o u l l i undertook the task to study the mortality rates caused by smallpox at various ages and the 49 r e s u l t s were reported to the Academie on 30 A p r i l 1760. Bernoulli's general conclusions were that inoculation, though i t did involve a r i s k , could lengthen the l i f e span of human beings by approximately three years; and secondly, that one stood a better chance of contracting smallpox during early childhood. D'Alembert, the co-founder of the Encyclopedie, read tovthe Academie on 12 95. November 1760, an elaborate memoir which argued against his a n a l y t i c a l method and concluded: Enfin les hypotheses de ce grand geometre sur. l e risque d e l ' i n o c u l a t i o n ne sont peut-etre pas plus exactes; i l faudrait savoir s i cette: operation emporte toujours comme i l le suppose, l a meme part i e des inocules, a-quelque age, qu'on les inocule. In refuting Bernoulli's research, D'Alembert was, in fact, unable to f u l l y understand what could be achieved by the application of p r o b a b i l i t y theory. Despite the e a r l i e r work of Huyghens, Laplace and Jacques B e r n o u l l i , D'Alembert refused to acknowledge that the c a l c u l a t i o n of 51 p r o b a b i l i t i e s was a legitimate branch of mathematics. In mathematics he wanted to be absolutely c e r t a i n and precise, and on the subject of inoculation he wrote: J'avouerai cependant que s ' i l n'y avait que des d i f f i c u l t e s de cette esp£ce qui empechassent de f i x e r par le c a l c u l les avantages de 1'inoculation, ces d i f f i -cultes n'auraient l i e u qu'a raison de 1'imperfection actuelle de nos connaissances sur cette matiere, et le pet i t e nombre d' observations certaines qu'on a r e c u e i l l i e s jusqu'a present.52 As long as thi s attitude persisted, i t was d i f f i c u l t for D'Alembert to acknowledge the " s c i e n t i f i c " character of methods encompassing p r o b a b i l i t y and of advancing the practice of inoculation. I t must be pointed out, however, that D'Alembert was not i n fac t opposed to inoculation. But he did increase each ind i v i d u a l ' s fear of the r i s k s of inoculation: Qu'on peut mourir de l a petite verole a r t i f i c i e l l e ; e l l e v o i t 1'inoculation comme un p e r i l instant et prochain de 96. perdre l a vie en un mois, et l a petite verole comme un danger i n -certai n , et dont on ne peut assigner l a place dans le cours d'une longue vie.53 And, ."it was due to thi s kind of statement that l e d Diderot i n 1761, through his i n t e r e s t i n preventing smallpox, to write a c r i t i q u e of D'Alembert's memoir on 54 inoculation. As a partisan of inoculation, he believed that D'Alembert was jeopardizing the best in t e r e s t s of French society i n general: On a trop confondu, d i t M.D'Alembert, l ' i n t t r e t public avec l ' i n t t r e t p a r t i -c u l i e r . Cela se peut, mais c e l u i qui -. ; : apprend aux hommes a stparer ces deux i n t t r e t s est un bon gtometre, a l a bonne heure, mais un tres-mauvais citoyen.55 Economic considerations were gradually becoming of primary importance i n shaping the position:of governmental authorities toward the inoculation of the urban and "sick" poor. La Condamine believed that the deliberate immuni-zation against smallpox could play an important role i n the saving of human l i v e s . In the f i r s t memoir, he estimated: De vingt m i l l e personnes qui meurent par an dans Paris, cette t e r r i b l e maladie en emporte done quatorze cens vingt-huit. Sept f o i s ce nombre des malades de l a pet i t e vtrole a Paris, annte commune. Si tous les ans on i n o c u l o i t en cette v i l l e dix mi l l e personnes, i l n'.en mourroit peut-etre pas trente, a,;,raison de t r o i s par m i l l e ; mais en supposant contre tout p r o b a b i l i t y q u ' i l mourut deux inocults sur cent au l i e u d'un sur t r o i s ou quatre cens, ce ne s e r o i t jamais que deux cens personnes qui mourroient tous les ans de l a pet i t e v t r o l e , au l i e u de quatorze cens vingt-huit. II est done demontre que 1' etablissement' de 1'Inoculation sauveroit l a vie a douze ou t r e i z e cens citoyens par an dans l a seule v i l l e de Paris, & a plus de vingt-cirig,. m i l l e personnes dans l e royaume suppose, comme on l e presume, que l a capitale contienne l e vingtieme des habitans de l a F r a n c e . ^ Undoubtedly, he was appealing d i r e c t l y to the economic i n -terests of France as a whole. This program i s of h i s t o r i c a l s ignificance because i t provides an important clue to ex-p l a i n why c e r t a i n "enlightened" governmental authorities began to show a growing i n t e r e s t i n new measures to m i t i -ga te sma1lpox. By the mid-century, "enlightened" governmental -authorities increasingly turned t h e i r attention to the issues of health and s o c i a l p o l i c y derived from t h e i r approaches to p o l i t i c a l economy. The theory and practice of p o l i t i c a l economy dealt with such key issues as a g r i -5 8 ' c u l t u r a l productivity, population p o l i c y and poor r e l i e f . Among p o l i t i c a l economic ideas, the concept of increased a g r i c u l t u r a l productivity was one of the most fundamental 59 and important during the period under discussion. In short, increased a g r i c u l t u r a l productivity required a large and growing population, but the advantages of t h i s resource could be achieved only by having as many of the people as possible productively engaged. Hence, the larger question of productivity rested on the understanding of health-6 0 related problems that concerned the poor. In this connection, the importance of adequate medical care i n r u r a l areas was now recognized as one of the main objectives 98. i n the measures for the maintenance of a healthy popu-l a t i o n capable of productive labor which, i n turn, con-61 tributed to the wealth and power of the state. In light".of the significance of a healthy and grow-ing population for the state, Montyon, the celebrated s t a t i s t i c i a n , as late as 1778 concluded that, i l [the king], d o i t soutenir l e pauvre par des reglemens, l ' e c l a i r e r par des inst r u c t i o n s , l e secourir par des d i s -positions l i b e r a l e s ; mais quel que s o i t l e regime m i n i s t e r i a l , i l faut que d'une maniere quelconque l a nourriture du peuple s o i t assuree, s i l'on veut prevenir les pertes qu'eprouve l a population, par l a quantite de pauvres que f a i t p e r i r l e manque d'aliment ou l a mauvaise qualite des denrees dont i l s sont forces de f a i r e usage...62 I t appears that the r e l i e f of the poor was an important po l i c y to be c a r r i e d out through the agency of the state, p a r t i c u l a r l y since the poor comprised part of i t s wealth. In this respect, "enlightened" governmental authorities believed that such a measure to improve health must deal equally with the economic, s o c i a l and medical aspects of the problem. Unlike England which could r e l y upon the London B i l l s of Mortality and parish registers for t h e i r s t a t i s t i c a l calculations to counterbalance theological disputes, La Condamine lamented that v i t a l s t a t i s t i c s such as mortality l i s t s , studies on medical-topographies and meterological observations had not been recorded i n France for more than a century: S i nous avions depuis un s i e c l e en France comme a Londres, & en quelques autres v i l l e s de 1' Europe, des l i s t e s mortuaires qui nous i n s t r u i s s e n t non seulement du nombre des morts, mais de leur age & de l a maladie a"laquelle i l s ont succombe, outre les consequences qu'on en pourroit t i r e r pour resoudre divers problemes politiques & moraux, i l est evident que l a comparison de semblables l i s t e s donnees en divers pays nous apprendroit que t e l l e ou t e l l e maladie est plus ou moins commune en t e l ou t e l canton, plus ou moins dangereuse en t e l autre & que nous t i r e r i o n s de-la de nouvelles lumieres sur 1'influence du climat, sur l a nature des alimens, sur l ' e f f i c a c i t e des differens remedes & sur les diverses m£thodes de t r a i t e r une meme maladie en differens lieux.63 D'Alembert, too, i n s i s t e d that doctors i n every town keep precise records of t h e i r smallpox cases i n regard to temperament, age, season and so forth, so that, Ces donnes au public par les Facultes de medecine ou par les p a r t i c u l i e r s , seraient certainement d'une u t i l i t y plus palpable et plus prochaine que les rec u e i l s d' observations meteorologiques p u b l i c s avec tant de soin par nos Academies depuis 70 .. ans.64 The French proponents of inoculation, however, were forced to r e l y e n t i r e l y upon English data, the most recent being the annual reports of the London Smallpox and Inoculation Hospital which were sometimes reprinted i n standard . . 6 5 p e r i o d i c a l s . Since knowledge was c l e a r l y designed to be the ornament and tool of authority, new i n s t i t u t i o n s , i f they were going to survive, had to serve the nation rather than form i t . In t h i s respect, the French partisans stressed the need for governmental support for the practice of 100. inoculation. Economically speaking, t h i s meant that population constituted part of i t s wealth and therefore the governmental authorities should contemplate and adopt a new measure l i k e inoculation. Unlike England, there was no organized system of poor r e l i e f at the hospital or parish l e v e l for the free inoculation of the poor. Hence, i n order to stimulate the governmental authorities to act on behalf of inoculation, a proposal was advanced which suggested that the government e s t a b l i s h an inocula-tion hospital to overcome t h i s problem. According to Bachaumont, the s o c i a l c r i t i c and l i t e r a r y observer of 66 Parisian society, the Hopital Saint-Louis was proposed. But he pointed out that the governmental authorities showed l i t t l e i n t e r e s t i n putting forward new legal measures to est a b l i s h an inoculation h o s p i t a l : Au reste, ceci ne pa r o i t encore qu'un projet rtpandu dans l e public suivant 1'usage, pour fonder ses dispositions, & le preparer insensiblement a l e recevoir. II tprouvera, saris doute, beaucoup de contradictions & de discussions, comme en tprouvent en France tous les tstablissemens nouveaux, meme les plus avantageux, & c e l u i - c i a de puissans adversaires dans le sein de l a Faculty meme, non que parmi les gens i n s t r u i t s i l puisse se trouver des dttracteurs de bonne f o i , mais parce que l a passion & l a cabale i n f l u e n t sur tout, & que^l'amour-propre combat encore par opi n i a t r e t t en faveur d'un mauvais systeme, meme lorsque 1'esprit est con-vaincu. 6? The attempt to es t a b l i s h a hospital which could have been used for the inoculation of the poor such as the Hopital Saint-Louis was s i g n i f i c a n t i n that i t showed how learned 101. men i n general were slowly grasping* a knowledge of i s o l a t i o n and quarantine measures for the purpose of con-6 8 t r o l l i n g a contagious disease. In addition, the practice of inoculation could have become popular i n large towns l i k e Paris i f the establishment of s p e c i a l i n s t i t u t i o n s such as the Hopital Saint-Louis for the inoculation of the poor had occurred. Although "enlightened" governmental authorities re-cognized the need of the state for p o s i t i v e action i n re-" l a t i o n to p o l i c i e s and measures intended to foster good health and population growth, i t was clear that the popu-l a t i o n question was not a simple matter of mere numbers, but a more complex problem whose solution was grounded on measures calculated to improve health-related conditions of the poor. Moreover, the prevalence of inadequate medical care and unequal d i s t r i b u t i o n of medical personnel served as major obstacles to an increasing healthy popula-ti o n and governmental action to r e l i e v e the suffering masses 69 during the period under discussion. Despite the e f f o r t s which Turgot's administration launched against epizootic and epidemic diseases i n the 1770s to bring order and, whenever possible, solutions to medical problems, the problem of poor r e l i e f was further exacerbated by the high price of treatment demanded by p r a c t i t i o n e r s and parsimoniousness among l o c a l a u t h o r i t i e s * ^ By the late eighteenth century, the basic p r i n c i p l e of medical care i n France was that poor r e l i e f should be pro-vided on a l o c a l scale as far as possible. Each community 102. was supposed to care for i t s own "sick" poor and i n some 71 instances, poor r e l i e f was provided by the Church. The unsatisfactory nature of the type of provision of poor r e l i e f i n some of the small towns was noted by the p r i e s t of Murlin in".1783: - Most poor parishioners:, .-.-don.'t dare turn to the surgeons, who charge too much for th e i r travels and t h e i r remedies. I see sick people v i s i t e d f i v e times and treated with some ordinary remedies, for which surgeons l i v i n g just a league away are paid forty-four pounds.72 I t appears that t h i s kind of high price of poor r e l i e f was not untypical of the time. This type of expenditure was obviously a disincentive for parish authorities to provide r e l i e f to the "sick" poor as late as the 1780s. Moreover, Robert He l l e r recently pointed out, i n a study of German society, one of the reasons why public i n -s t i t u t i o n s f a i l e d to deal e f f e c t i v e l y with poor r e l i e f at the l o c a l l e v e l : Although the members of the French r u r a l clergy, as everywhere else i n Europe, gave medical aid to the i r parishioners i n d i v i d u a l l y , when needed, there existed no scheme during the ancient regime to integrate them into a system for the medical care of the poor which was ad-ministered or at l e a s t i n i t i a t e d by the state.73 In f a c t , the p r o v i n c i a l or royal authorities stepped i n only when problems of r e l i e f were too large for the l o c a l community to handle. This usually took place during the period of widespread epidemics in which the medical per-74 sonnel were dispatched to the ravaged area. Yet i t 103. must be remembered that the problem of medical personnel was not limited to periods of epidemic outbreaks. Through-out the eighteenth century, contemporaries lamented that there was a great shortage of learned doctors and surgeons • 4-v, 7 5 i n the r u r a l areas. F u l l y aware of the inadequacies of medical practice, Montyon strongly urged that more attention be paid to making 7 6 available the services of competent doctors and surgeons.. According to Montyon, C'est encore un probleme de savoir s i l a Medecine d e t r u i t plus d'hommes qu'elle n'en sauve. Dans les grandes v i l l e s ou sont e t a b l i s les Medecins les plus habiles & les plus experimentds, le r e s u l t a t des secours q u ' i l s administrent. doit etre superieur a c e l u i de leurs f a u t e s . 7 7 This, however, was apparently not the case i n small towns and r u r a l areas as he noted: .. .Mais, dans les petites v i l l e s & les cam-pagnes qu'habitent les Medecins qui ont l e moins de sens, de talent & d'experience, i l s e r o i t plus sage, au dire meme des plus fameux Docteurs, de s'en rapporter a l a nature & d' expulser une foule de charlatans recus ou non dans les Facultes, qui vendent a l a foiblesse credule & stupide leurs erreurs & l a mort.^ 8 Moreover, Montyon indicated that i n addition to curative medicine there was a preventive medicirie7 associated with the Royal Administration-la police generale - which was 7 9 " e s s e n t i e l l e a l a conservation de l a sante publique." While t h i s branch of medical practice had been recognized and applied with some b e n e f i c i a l r e s u l t s i n France, he wrote d i r e c t l y on the need for better environmental sani-tation i n terms of housing and improved d i e t for the poor: 104 . Que de maladies on doit encore a l a mauvaise construction des maisons, de c e l l e s qui sont au niveau des terres, ou qui y sont i n f e r i e u r e s , de c e l l e s qui n 1ont pas suffisamment d'ouvertures pour l a i s s e r un l i b r e cours a l ' a i r le moins sain; le danger est encore plus grand dans les maisons construites de pierres de p l a t r e , ou de torchis, qui dans des temps d'humidite exhalent une vapeur souvent i n v i s i b l e , mais toujours n u i s i b l e & pernicieuse: une source de destruction plus seconde encore, est l a mauvaise qualite des alimens, des boisson, des eaux saumatres, douces, terreuses, chargees de parties metalliques, l e vin ou le l a i t a i g r i , boisson ordinaire des campagnes, l a viande gatee (le pauvre cultivateur n'etant pas en etat d'en con-sommer de meilleure) les f r u i t s verds, l a misere ne permettant pas d'attendre l a saison'de l a maturite. 80 Indeed, Montyon's views and goals were shared by many contemporaries who increasingly looked to the state for p o s i t i v e measures and p o l i c i e s i n dealing with health-related problems and society. Health, i n short, became associated with improvements i n l i v i n g conditions and n u t r i t i o n and i t s maintenance became the task of "enlight-ened" governmental authorities and medical men. As we have already noted, i t was becoming clear - at le a s t i n terms of "enlightened" opinion - that improvements i n public health were an o b l i g a t i o n of society to be c a r r i e d out through the agency Of the state. The remaining issue.checking the practice of inocula-t i o n was the fear that i t would spread smallpox to un-protected people. This invar i a b l y led to cert a i n forms of p r o h i b i t i o n of the p r a c t i c e . In the autumn of 1762 a severe smallpox epidemic a f f l i c t e d the town-dwellers i n 105. Paris and continued into 1763. Alarmed by the unabated spread of smallpox i n P a r i s , a n t i - i n o c u l a t i o n i s t s claimed that i t s unusual duration was to be ascribed to the i n -creasing practice of inoculation - a charge which, though most unjust, was yet plausible because inoculation was 8 2 capable of spreading smallpox. For example, Angelo Gatti described the ways i n which the contagion spread during t h i s period: L'hotel-Dieu, qui se trouve au centre de Paris, renferme le plus souvent 2 ou : 300 malades de l a p e t i t e verole; les en-fans du peuple couverts de boutons, d^goutons de cette maladie, se promenent dans les rues, jouent indifferemment avec ceux qui ont eu l a petite verole ou non. Les Me*decins, les Chirurgiens, les Pretres, les garde-malades au s o r t i r d'une maison, dans laquelle peut-etre les uns sont mo'rts de la- petite ve"role, les autres moribonds, les uns estropies par des ulceres qui achevent d' i n f e c t e r avec l a puanteur de leur matiere sanieuse, l ' a i r empoisonne des malades de l a p e t i t e ve*role couverts de pied en cap d'une croute hideuse; tous ceux qui, a i n s i que les domestiques & c , au s o r t i r d'une p a r e i l l e maison entrent dans une autre, peut-etre dans quartier ou l a p e t i t e verole n'existe pas encore, y portent l'epiddmie sans que personne se r d c r i e contre ces abus.^3 On the basis of t h i s contemporary observation, i t was clear that i s o l a t i o n , quarantine and any other public health measure to prevent the spread of smallpox was sorely lack-ing at the time. I t i s aiso i n t e r e s t i n g to note that the townspeople i n Paris seem to have been less careful when the disease was present i n the area and of the marginal length to which people would go to avoid contracting i t . Perhaps this was due to the f a c t that i n "large towns such as Paris the urban poor generally helped 'their""neighbors^ 106. and Sid .not. flee from the place where'; smallpox raged. The reaction achieved i t s culmination on June 176 3, when Omer Joly de Fleury, the avbcat general i n the Paris Parlement - an opponent of the philosophies who had pre-viously banned the publication of the Encyclopedic -issued a r t q u i s i t o i r e "par lequel i l est f a i t defenses provisoirement de l a pratiquer dans l'enceinte des v i l l e s 84 & des faubourgs". until"both the Paris Faculty of Medicine and of Theology had decided whether i t should be 8 5 permitted, forbidden or tolerated. Towns outside of i t s j u r i s d i c t i o n were s t i l l allowed to inoculate provided that patients remained i n quarantine or i s o l a t i o n for a period 86 of six weeks afte r t h e i r exposure. Since Fleury and many contemporaries believed that inoculated smallpox was' highly "contagious this: was''.a" very important p r a c t i c a l issue, as i t revealed how during an epidemic town authorities adopted measures to i s o l a t e inoculated cases from other members of the community. The r e q u i s i t o i r e of Fleury was viewed as something more than a mere matter of inoculation's s o c i a l e f f i c a c y . I t involved a query of primary importance, namely, whether the Church, represented by the Faculty of Theology, should have the r i g h t to l e g i s l a t e i n a medical a f f a i r . The whole movement toward enlightenment was involved. D'Alembert wrote d i r e c t l y on the role of the Theology Faculty in the controversy: 107. L 1 inoculation n'est pas plus du--ressort de l a theologie, que les matieres de l a predestination et de l a grace ne sont du ressort de 1'arithmetique et de l a mede-cine...La question d e l ' i n o c u l a t i o n est sans doute bien plus du ressort de l a Faculte de medecine que c e l l e de Theologie. V o l t a i r e also pointed out the, interference of r e l i g i o n into medical a f f a i r s i n his caustic s a t i r e of Omer de Fleury and wrote: Et comme ce qui peut interesser l a r e l i g i o n ne regarde en aucun maniere l e bien public et que le bien public ne regarde pas l a r e l i g i o n i l faut consulter l a Sorbonne qui par etat est charged de decider quand un Chretien doit etre saigne et purge; et l a Faculte de Medecine chargee par e'tat de savoir s i 1'inoculation est permise par le d r o i t canon.88 But these fears were allayed when the Faculty of Theology declared that the issue was i n fact medical and not 8 9 th e o l o g i c a l . In accordance with the r e q u i s i t o i r e , the Paris Faculty of Medicine i n 1764 appointed twelve of i t s p r a c t i t i o n e r s from both factions, i n favor or adverse to inoculation, to form an investigative committee which i n turn sent a questionnaire to doctors throughout Europe. This questionnaire was a s i g n i f i c a n t aspect of the En-lightenment for i t grew out of the government's need to obtain r e l i a b l e medical information and advice on whether to accept or. f o r b i d the practice of inoculation. Asse- .". mbling on a regular basis, the committee c a r e f u l l y studied and analyzed a l l the material so far written on'.'the subject and tabulated the r e p l i e s to i t s questionnaires which had 108. been received from prominent medical men such as John Huxham and John Pringle i n England and Alex Monro i n 90 Scotland. The four queries were: 1. depuis quand on i n q c u l a i t dans leurs pays, et avec quels resultants; 2. l a mortalite de cette operation; 3. sa valeur preventive contre l a v a r i o l e ; 4. les accidents concomitants et u l t e r i e u r s , et leur frequence par rapport a ceux de l a peti t e verole. According to Delaunay, the foreign correspondents ....... 91 sanctioned the practice of inoculation. While Par i s i a n society awaited the outcome of the inquiry, the committee made i t s own decisions. Inter-estingly, six doctors were i n favor of at lea s t t o l e r a t i n g inoculation outside the boundaries of large towns u n t i l more experimentation made i t seem, plausible to extend i t throughout France, and six were sternly opposed to the pra c t i c e . These two minority groups presented preliminary reports to the Faculty. The f i r s t was supplied by " ' ' Guillaume Joseph de l'Epine, erstwhile Dean and leader of the a n t i - i n o c u l a t i o n i s t s party, on 29 August 1764. Re-presenting the view of his fellow committeemen, Jean Astruc, M.P. Bouvart, Th. Baron, Verdelhan des Moles and Macquart, L'Epine read his report which claimed that ino-culation was a dangerous practice and capable of spreading smallpox: La p e t i t e verole est contagieuse.; e l l e se gagne par attouchement, par communication, par frequentation. On peut etre attaque* plus d'une f o i s de cette maladie; les preuves de f a i t n'en sont pas rares. L' Inoculation ne guarantit pas de l a rechute; 109 . i l est encore prouve par les f a i t s que l'on meurt tres bien de la^ p e t i t e verole a r t i f i c i e l l e . L ' i n s e r t i o n de cette maladie expose l a vie des Citoyens qu'.elle l i v r e au danger de l a gagner par communica-ti o n . En inserant le virus v a r i o l i q u e , on peut introduire d 1autres miasmes dans le sang de l'Inocule.92 On 5 September 1764, Antoine P e t i t , the celebrated anatomist and academician, read to the assembly his report i n favor of inoculation with the support of his associates Cochu, Geoffroi, Lorry;.Maloet and Thierry. Subsequently, a vote of the medical men present was taken which re-93 suited m only the t o l e r a t i o n of the p r a c t i c e . However, three separate assemblies and deliberations were required i n order to obtain an authorized Faculty decree. This in turn enabled the a n t i - i n o c u l a t i o n i s t s party to oppose the practice on medical and r e l i g i o n 94 grounds for the next four years. L'Epine's work appeared 95 f i r s t i n 1765. Addressed to the members of the Faculty, he presented a scholarly assessment of the main p r i n c i p l e s advanced by the partisans of inoculation and then refuted t h e i r arguments d i r e c t l y . For example, L'Epine echoed the r e l i g i o u s prejudices against i t and wrote: Demander s i l'on peut permettre ou t o l e r e r 1'Inoculation, e'est demander a quelqu'un qui se porte bien, s ' i l l u i est permis de l a donner une maladie dont i l peut mourir & par consequent s ' i l peut courir les risques d'etre homicide de lui-meme & de ceux q u ' i l pourra i n f e c t e r par les emanations de son corps.96 In his own general and personal observations, L'Epine also noted that the practice of inoculation was indeed f a i r l y 110. dangerous: Madame de l a Moignan, s'etant f a i t inoculer, a eu a l a suite de l a petite verole que l u i avoit procure cette operation, au moment ou e l l e se croyoit guerie & quitte de l a maladie, un depot s i considerable a un genou, qu'apres avoir r e s i s t e a tous les remedes, i l a et& question de l ' o u v r i r ; qu'on a long-terns apprehende qu'elle n'en restat estropiee toute sa vie....Un des ses f i l s , inocule en meme temps qu'elle a eu une grosse f i e v r e , a ete tres-grievement malade, & sur le point de p^rir.97 With the appearance of the work, foreign correspondents of England complained that t h e i r reports had been distorted and La Condamine remarked: La Faculty de medecine de Montpellier, ni aucune autre du royaume, n i des Universites etrangeres n'ont pas ete consultees, non plus que l e college des mgdecins de Londres.98 These were not the only i s o l a t e d accounts of the attempt by L'Epine and associates to d i s c r e d i t the practice as i s shown i n a l e t t e r to Freron i n L'Annee L i t t e r a i r e i n 1765 from de La Moignon who claimed: Ce r ^ c i t est depourvu. de toute v e r i t y . Madame de l a Moignon a ete inocuie le 28 Mars 1764. La petite verole a paru le 5 A v r i l ; l e 10 e l l e s'est sentie de '.=.-. l a roideur dans un genou, & s'est apperc^ue qu'au dessus du meme genou i l y avoit de l a rougeur; v o i l a l e commencement de son depot qui n'a ete totalement gueri que le . 23 Mai. Ce depot, qui n' e t o i t pas f o r t considerable, n'a jamais e t e ouvert';. des .1 cataplasmes d'lierbes emollientes & de mie de pain & de l a i t l'ont aide a. s' ouvrir de lui-meme? pendant tout son cours Madame de.la Moignon n'a eu que t r o i s jours l a fievre l e s o i r . 9 9 Further on, he described another inaccurate account of the symptomatic experience: Ma f i l l e ainee (& non un f i l s ) inoculde le meme jour qu'elle, c'est-a-dire, le 5 A v r i l ; ce jo u r l a & l e s deux suivants, c'est-a-dire, le 6 & le 7, e l l e a eu l a fievre assez forte meme l a tete un peu embarassee; le 8 A v r i l e l l e s'est levee, & depuis s'est portee a merveille; sa sante s' est meme f o r t i f i e e . Pendant les t r o i s jours de f i e v r e , i l n'y a jamais eu le moindre danger pour sa vie.100 These accounts, however, did not change L'Epine's view or the anti-inoculationist; 1 position about the degree of danger of inoculation to people. In 1766, the p r o - i n o c u l a t i o n i s t p o s i t i o n was published. I t was in d i r e c t contrast to the scholarly document of L 'Epine. Antoine P e t i t ' s celebrated report on inoculation was addressed to the French public i n general rather than to the F a c u l t y . A s we have already noted, the dangers of the practice of inoculation were a very important p r a c t i c a l issue as i t would probably a f f e c t the outcome of the decision by the Faculty. Based on his own general and personal experiences i n Paris and elsewhere P e t i t noted that death from inoculation did occasionally a r i s e , but i t was almost c e r t a i n l y a function of the inoculator's lack of s k i l l and his imperfect method: Quelques personnes sont mortes apres avoir 6t6 inocultes, mais ce n'est pas 1'inoculation elle-meme qui les a conduites au .tombeau, e'est 1'inoculation pratiquee dans de mauvaises circonstances, e'est 1'inoculation mal administree.102 Althouth P e t i t did not question the p o s s i b i l i t i e s of death from inoculation, the d i f f i c u l t y of defining p r e c i s e l y the 112. cause of death was a major problem confronting medical p r a c t i t i o n e r s during the eighteenth century. Indeed, t h i s must be kept i n mind, for i t i s . s t i l l with us today. In addition, P e t i t pointed out the probable e f f e c t s of inoculation i n recent times by means of i t s mathematical ca l c u l a t i o n s : II est demontre d'apres les cal c u l s les plus exacts que les deux t i e r s des hommes sont attaques de l a petite verole une f o i s dans l a v i e . Sur t r o i s cens, deux cens doivent I 1 a v o i r ; i l en meurt vingt; s ' i l s / avoient ete inocules, i l en auroit peut-etre p e r i un seul, & les dix neuf autres auroient ete sauves. Les a n t i - i n o c u l i s t e s disent que s i c'est un bien pour l e general, c'est un rnal pour le p a r t i c u l i e r . Cette maxime ne peut-etre plus mai appliqu^e; car s i 1'on sauve dix-neuf p a r t i c u l i e r s , n'est-ce pas un grand bien pour chacun d'eux de jo u i r de l a vie q u ' i l s auroient perdue sans 1'inoculation?103 As we have seen, t h i s was the c h a r a c t e r i s t i c approach of the philosophies, who placed their ultimate strength i n en-lightening public opinion rather than i n resting on i n -s t i t u t i o n a l i z e d t r a d i t i o n a l p ositions. During the course of the years 1766-176 8 both P e t i t and L'Epine presented supplementary reports to the Paris Faculty with rejoinders that reopened the debate "avec querelles memes indecentes." F u l l y aware that the a n t i -i n o c u l a t i o n i s t positon was rapidly losing, ground within the Paris Faculty because, " I l s avaient ressemble tous les v i e i l l a r d s , les infirmes, les podagres, les docteurs 104 les plus obscurs, en un mot; l a l i e de leurs confreres," they made vigorous e f f o r t s to avert defeat. With every means at t h e i r disposal, they established. a precedence i n l egal procedures, namely, the vote by b a l l o t , with the r e s u l t that an o f f i c i a l decision was never given. But t h i s measure made l i t t l e difference. Doctors i n Paris ignored the r e q u i s i t o i r e and inoculation continued to spread, among the wealthy and p r i v i l e g e d , within and out-105 side the towns under i t s j u r i s d i c t i o n . Indeed, the stern laws laid.down by the parlemeritaires, when they were not followed by equally rigorous police measures to check the i l l e g a l p r actice, did more harm than good for the an t i - i n o c u l a t i o n cause. The program had partisans i n high places: for instance, the Minister of Foreign A f f a i r s , the Due de Choiseul. I t i s said, moreover, that the police were unable or unwilling to apprehend those who v i o l a t e d the law, because the Lieutenant-General of the Police was 106 a partisan of inoculation. In f a c t , by ignoring the ban oniinoculation, the governmental authorities i n e f f e c t overrode the authority of the Paris Parlement. Inoculation was permitted, and i t was acknowledged that t h i s was, to a considerable extent, a personal triumph for La Condamine."1"^ The general acceptance was further confirmed i n 1769 when Angelo Gat t i was o f f i c i a l l y instructed, by the Due de Choiseul, to inoculate a l l those students at the Ecole Royale M i l i t a i r e de l a Fleche who had not contracted the 108 disease. The anonymous writer noted the triumph of inoculation when.the practice of the G a t t i method was used i n 1769: 114 . Vous avez vu, Monsieur, avec qu'elle ardeur nous nous sommes presentes a l'ennemi, avec qu'elle i n t r e p i d i t y nous avons soutenu ses approches, & avec quel courage nous avons brave ses coups. Notre exemple pourra s e r v i r a bannir les pr^juges de l a nation qui sont les ennemis de l a f e l i c i t e publique. The l a s t s i g n i f i c a n t h i s t o r i c a l event took place within the Court i n 1774 when Louis XV was a f f l i c t e d with smallpox and i n fourteen days he was dead. His demise, i n turn, led to the inoculations of the royal family which marked the removal of the l a s t royal t r a d i t i o n a l bastion i n Europe which had not sanctioned the medical p r a c t i c e . 1 1 0 Although the controversy over inoculation did not cease completely i n 1774, a general investigation of the most recent available l i t e r a t u r e between the years 1774-1790 provides l i t t l e new i n s i g h t into the nature of the struggle and the attitudes of the competing positions within the learned community. During the course of the l a t e eighteenth century, medical men either demonstrated slow, deliberate steps to spread the practice of inoculation, p a r t i c u l a r l y to the suffering masses, or they continued to show a re-luctance to accept t h i s medical p r a c t i c e . 1 1 1 The medical profession as a whole did, however, operate on the assumption that c l i m a t i c conditions were a key factor i n i l l n e s s which, i n turn, may have explained the sudden onset 112 and devastating nature of severe epidemics l i k e smallpox. And yet, i n order for the practice of popular ino-culation to be possible, i t was necessary for the price of inoculation to be r a d i c a l l y reduced from what i t was during the period under discussion. To do t h i s , i t was necessary to introduce d i f f e r e n t i a l prices according to the f i n a n c i a l circumstances of t h e i r patients. This type of price discrimination could have become the most f r e -quent method by which the professional inoculators maximized both numbers inoculated and p r o f i t . Economic considerations were obviously of primary importance i n determining the attitudes of l o c a l authorities and medical personnel towards the inoculation-of the poor.. But a s t r i c t parsimonious attitude among medical men as a whole served to blunt the r e a l i z a t i o n that i t would be cheaper to inoculate the poor than to nurse, feed, i s o l a t e and sometimes bury them a f t e r they had contracted natural smallpox. Since the price of ino-c u l a t i o n was r e l a t i v e l y high during t h i s period, most parish authorities i n the large and small towns were un-w i l l i n g to pay for the inoculation of the poor. In fact, there i s no evidence of a mass-scale inoculation being paid for by the overseers of the poor or of a large number of the poor being inoculated during a smallpox epidemic. Unfortunately, many contemporaries were not very aware of the p o t e n t i a l economic advantages of inoculation during the eighteenth century. Moreover, amateur inoculators could have played an important role i n both reducing the price of inoculation and making i t available to the suffering masses who could 116 . not obtain i t otherwise. Some amateurs could have practiced as i t i n e r a n t inoculators by the late eighteenth century. They could have practiced inoculation cheaper than the professionals and have been s t i l l concerned with the p r o f i t a b i l i t y of the p r a c t i c e . Although i t i s beyond the scope of this study, i t i s possible to learn a great deal about the practice of ino-culation at the end of the eighteenth and beginning of the nineteenth century by focusing on the spread of vaccination. In fact, i t appears that vaccination was much more popular in France than i t was i n England during the early nine-teenth century/ i n d i r e c t l y confirming the conclusion that inoculation was less popular than vaccination by the end of the eighteenth century. Perhaps the general acceptance of vaccination was therefore a l o g i c a l outgrowth of conte-. :• mporary b e l i e f and p r a c t i c e . Contemporaries f a m i l i a r with inoculation expected to be protected for a l i f e t i m e , and vaccination only protected for r e l a t i v e l y short periods, although i t s i g n i f i c a n t l y mitigated the severity of attacks even i n the longer period. This affected not only the attitude of the population i n general but also the medical profession i t s e l f , most of whom had been i n i t i a l l y 113 enthusiastic supporters of vaccination. By 1775, however, the controversy had to a considerable extent ceased within the learned community and inoculation against smallpox became a generally accepted, though'not unive r s a l l y established, medical practice i n France u n t i l i t was supplanted by the vaccine method of the English doctor, Edward Jenner, i n 1798. NOTES Theodore Tronchin, a r t . "Inoculation, 1 1 En-cyclopedie,p.726, pointed out: "Deux des princesses furent alors hardiment inocul6es;& de 182 personnes qui le furent dans l e courant de cette annte i l n'en mourut que deux. De 897 qui le furent jusqu'en 1728, i l en mourut 17," tandis q u i ' i l parut par les b i l l s mortuaires que dans de terns, l a p e t i t e verole naturelle avoit emporte un dou-zieme du t o t a l des morts." 2 La Condamine, "Memoire sur 1 1 inoculation de l a pe t i t e verole," H i s t o i r e de 1'Academie Royale des Sciences (Paris, 1754), p.624. 3 Genevieve M i l l e r , The Adoption of Inoculation  for Smallpox i n England and France (Philadelphia, 1957), p.137. 4 I b i d . , p.132. 5 This point i s made i n the i n t e r e s t i n g study by C y r i l B.O'Keefe Contemporary Reactions to the Enlightenment  172 8-1762 (Geneva 1974) , pp.48-49. See also the survey by Jacqueline de La Harpe, "Le Journal des Savants et 1' Angleterre 1702-1789," University of C a l i f o r n i a Publications  i n Modern Philology XX (1941), 6, pp.289-520. ^De La Harpe, p.376 . 70'Keefe, p.101. p La Mettrie, Traite de l a petite verole (Paris, 1740), p.9. Cited i n Marc Barblan, "La v a r i o l e dans l e Departement du Leman en 1811,(d'apres les registres de l a conscription napoleonienne)"/ Gesnerus 31 (19 74) , p.205 . Q Olwen H. Hufton, The Poor of Eighteenth-Century France 1750-1789 (Oxford, 1974), p.63. "Recherches sur quelques points- &'histoire de l a medecine," Journal de Trevoux LXV, (1775), p.256 . 118 D'Alembert, "Reflexions sur 1'Inoculation," Oeuvres completes, I, (Paris, 1821-22; re p r i n t ed., (Geneva: Skatline, 1967), pp. 486-87. ^ L a Condamine, "Memoire," p.658. 12 Condorcet, "Eloge de M. de La Condamine," Hi s t o i r e de 1' Academie Royale des Sciences (Paris, 1774), p. 110. As Condorcet pointed out i n 1774, t h i s day marked the beginning of an important period i n the l i f e of La Condamine: "Nous v o i c i arrives a l'epoque l a plus glorieuse pour l u i ; au moment d'une vie toujours s i bien employee, ou peut-etre i l a ete* le plus u t i l e . " 13 "Lettre de M. de La Condamine a M. Daniel B e r n o u l l i , " Mercure de France IV (1760), v.I, p.171-72. La Condamine wrote: "De retour de Paris, en 1745 [from a geodesic expedition i n South America], je r£solus de m'instruire a fond sur cette matiere. Je lus tout ce que je pus r e c u e i l l i r d 'ecrits sur 1 1 inoculation, publies depui trente ans, surtout en Angleterre. Je me convainquis de plus en plus, que 1'usage de cette pratique rendu gen^rale en France conserveroit tous les ans au moins vingt-cinq m i l i e sujets a l ' E t a t , & repareroit avec usure les petites journaliers, que f a i t parmi nous l a population par tant de causes reunis. J ' a i cru devoir a ma p a t r i e de l ' i n s t r u i r e de f a i t s , aussi connus chez nos voi s i n s , q u ' i l ignores parmi nous. J'en a i t i r e le consequences: j ' a i mieux aime* rendre palpables & mettre a,la portee de tout le monde, des v e r i t e s u t i l e s & trop peu repandus, que d'en chercher des nouvelles, qui pouvoient ne f a i t e plus d'honneur. Trop long-tems detourne par d'autres occupations, je ne pas executer ce pro j e t pendant plusieurs annees,'" 14 La Condamine, "Memoire," p.615. 15 Ibid., p.626. "^Ibid., p.652. For a sim i l a r discussion on Jurin's mathematical calculations, see Tronchin, p.759. 1 7 I b i d . , p.654 . 1 8 I b i d . , p.669. 19 Grimm, Correspondance l i t t e r a i r e , philosophique  et critique,. (Paris, 1878), v o l . I l l , p.205, stated: "M. de l a Condamine a f a i t une revolution en France par son Memoire sur 1'inoculation de l a pet i t e verole. M. de V o l t a i 119. en avait parle" dans ses l e t t r e s anglaises, sans f a i r e l a moindre impression sur l . 1 e s p r i t du public." "Eloge", p.112, Condorcet remarked that La Condamine wrote the memoir for the "gens du monde" and for "les meres tendres et dont le courage avoit besoin d'un appui." 2 0 J o u r n a l des Savants (July, 1754), pp.509-10. 21 L'Arinee/L11te r a i re VI, (1754) , p. 341. The main points contained i n both review a r t i c l e s are a summary of La Condamine's "Memoire." See L'Annexe Li'ttexaire VI (1754) , pp.192-209, 337-43. 2 2 J o u r n a l de Trevoux LIV (1754) , p.2357 . 23 ' ' . Hosty, "Rapport de M. Hosty, au sujet ae 1'inoculation," L'Annee Litte*raire IV (1755), remarked: "Les succes constans qu'a depuis 30 ans en Angleterre 1'inoculation de l a pe t i t e verole, & l e s avantages que l a France pourroit r e t i r e r en 1'introduisant chez e l l e , m*ont sur-tout determine a entreprendre ce voyage." 2 4 I b i d . , pp. 244-45 2 5 I b i d . , p.249 . 2 6 I b i d . , p.256. Cantwell, Dissertation sur 1'inoculation pour  s e r v i r de rdponse a c e l l e s de M. de La Condamine. Extract i n L'Annte L i t t e r a i r e V (1755), pp.261-88. 2 8 I b i d . , p.265. 2 9 I b i d . , p.266. 3 0 I b i d . , p.275 3 1 I b i d . , pp.274-75 . 32 "Rapport des quatres me'decins qui ont v i s i t e 1'enfant inocule, soupconne d'avoir eu une seconde pe t i t e verole," Mercure de France I (1759) , p. 164, Hosty pointed out: "L'homme seul, & tout homrae, & une seule f o i s est attaque de l a vraye p e t i t e verole & de l a rougeole. Mais i l ne tant .pas confondre avec ces deux malades c e l l e qu'on appelie p e t i t e verole volonte, en..Anglois .Chickenpox." 120. Another example of t h i s confusion was noted i n 176 3 by-Robert, a medical p r a c t i t i o n e r , who remarked: "Qu'il est f a c i l e de confondre. dans les premiers.temps une pe t i t e verole d i s c r e t t e avec une rougeole boutonnee." Cited i n Recherches sur l a nature et innoculation de l a petite verole. Extract i n L'Annee L i t t e r a i r e VI (1763), p.207. F i n a l l y , t h i s point i s also made i n the study by J.P. Peter. "Disease and the Sick at the End of the Eighteenth Century", trans. E. Forster i n Biology of Man i n History, R. Forster and O. Ranum Eds., (Baltimore, 1975), p.108, who wrote: " I t was a long time before 'f l y i n g samllpox' for a time mistakenly considered to be a highly contagious form of smallpox (variola) found i t s r i g h t f u l place as chicken-pox . " 33 . Grimm, p.210. 34 La Condamine, "Second Memoire sur 1'inoculation de l a petite verole, contenant l a suite d'histoire de cette methode & de ses progres de 1754 a "1758^"'Histoire\de 1 'Academie  Royal des Sciences (Paris, 1758) , p.455 . 3 5 I b i d . , p.459. 36 Charles Colle", Journal e t mgmoires sur les  hommes, les ouvrages dramatiques et les evenements les plus  memorables du regne de Louis XV (1748-1772). (Paris, 1868), I I , p.49. "Releves des baptemes, mariages et sepultures, par paroisse et avec des observations d'une minorite de subdeidgues: annee 1786," Cited i n J.P, Goubert, Malades et  Medecins en Bretagne 1770-1790, (Paris, 1974), p.323. This point i s further confirmed by Goubert, pp. 323-28, passim. 3 8 Le Camus, "Maison d'Inoculation," L'Annee L i t t e r a i r e , VIII (1770), pp.206-07. 39 "Rapport des quartres medecins," p.154. 4 0 I b i d . , p.165. 4 1 I b i d . , pp. 169-70. 4 2 "L'Inoculation de l a pet i t e verole deferee a L'Eglise et aux Magistrats," Journal de Trevoux LVII (1757), p.128. 121. 4 3 I b i d . , pp.128-29. 44 "Avis sur 1'Inoculation de l a Petite Verole," L'Annee L i t t o r a l r e VI, (176 3) , p.130. 45 See the excellent study on t h i s subject by Keith Baker, Condorcet: From Natural Philosophy to Social  Mathematics, (Chicago: 1975), pp.129-94 , passim. 46 La Condamine, "Memoire," p.649 . 4 7 v "Lettre de M. de l a Condamine a M. l e Docteur Maty," L^Annte L i t t e r a i r e VI (1764), p.287. La Condamine noted: "II est de f a i t que plus de trente m i l l e personnes en France sont tous les ans victimes de l a p e t i t e verole n a t u r e l l e , & qu'elle en mutile, estropie, ou defiguree un plus grand nombre. II est c l a i r que cette peste s e r o i t reduite a cent personnes au plus en supposant un accident sur t r o i s cens Inoculations; que par consequent cette operation generalement pratiquee conserveroit trente m i l l e sujets a l ' E t a t , & 1'usage de tous membres a trente m i l l e autres, en les preservant tous de di f f o r m i t e . La Nature, l a raison, l 1humanity doivent d e c i d e r . La Religion ne peut leur etre contraire. La question se reduit a c e l l e - c i : Entre deux dangers, dont 1'un est i n e v i t a b l e , Dieu permet-il de c h o i s i r le moindre?" 4 8 D a n i e l B e r n o u l l i , "Reflexions sur les avantages de 1 1 Inoculation," Mercure de France IV (1760) , v.I, p.140. 49 Be r n o u l l i , "Essai d'une nouvelle analyse de l a mortality causye par l a p e t i t e verole et des avantages de 1' inoculation pour l a prevenir," H i s t o i r e de l'Acadeinie  Royale des Sciences (Paris, 1760), p t . I I , ppl-45. 5 0D'Alembert, p.476. 51 This i n t e r p r e t a t i o n i s derived from the study by Keith Baker, pp.171-89. See also Arthur M. Wilson, Diderot, (New York, 1972) , pp.431-32; and M. Foucault, The B i r t h of  the C l i n i c trans. A.M. Sheridan Smith, (New York, 1973), pp .103-05 . 5 2D'Alembert, p.476. 5 3 I b i d . , p.478. 122. 54 Diderot, "De 1'inoculation," Oeuvres completes, v.IX Jules Assezat & Maurice Tourneux ed., (Paris, 1857) , pp.207-12. 5 5 I b i d . , p.211 5 6 La Condamine, "Memoire," p.666. 5 7 This point i s also made by Caroline Hannaway, "The Societe Royale de Medecine and Epidemics In The Ancien-.-Regime," B u l l e t i n of the History of Medicine, XLVI (1972) , pp.259-61. 5 8 For a general discussion.on the theories and practices of p o l i t i c a l economy which r e f l e c t e d the neo-m e r c a n t i l i s t , populationist and physiocratic positions; see Ronald Meek, The Economics of Physiocracy (Cambridge, 1963); Idem, Social Science and the Ignoble Savage (Cambridge, 1976); A. Hirschman, The Passions and the Interests (Princeton, 1977); and E. Fox-Genovese, The Origins of  Physiocracy (Ithaca, 1976). The work by Fox-Genovese i s an important one. She has argued that physiocracy as a doctrine did not e x i s t i n the 1760s. In fact, i t emerged, slowly and p a i n f u l l y , from the collaboration of Quesnay and Mirabeau and from the confrontation of t h e i r r a d i c a l l y d i f f e r e n t notions of the nature and needs of French govern-ment and society. For our purposes, the term " p o l i t i c a l economy" has been used i n a broad context i n order to discuss i t s e f f e c t s on public health i n eighteenth-century France. 59 See, for example, Hirschman, pp.98-102; Fox-Genovese, chaps. 2,3. fi 0 This point i s derived from the excellent study by Fox-Genovese, passim; see also the sophisticated discussion by Meek, Economics of Physiocracy, p.18 and passim: and idem, Social Science,^ pp. 6 8-99.. •••ii'*-..-. . . « -: 61 This position was formulated even more e x p l i c i t l y by Montyon, a populationist, i n 1778 i n the s t a t i s t i c a l work, Recherches et considerations sur l a population ,de l a  France (Paris, 1778) 2 vols. F u l l y aware of the relations between socioeconomic structure and health, Montyonr focused on such themes as high infant mortality among the poor, diseases r e s u l t i n g from the trades by which people were compelled to support themselves and t h e i r families, and i l l health produced by malnutrition and environmental conditions. For s i m i l a r discussion see Peter, pp. 81-124;and Hannaway .pp.- .257-73, p a r t i c u l a r l y , pp.259-61. 123. 6 2 Montyon, v o l . I, p.255 . 6 3 "Response de M. de l a Condamine au d e f i de M. Gaullard," Mercure de France IX (1759), p.193. 6 4D'Alembert, p.489. 6 5 -r See, for example, "Origine, progres, etat de l'Hopital de l a petite verole naturelle et inoculee, depuis q u ' i l a ete fonde a Londres l e 26 Septembre 1746, jusqu'en 24 mars 1763," L'Annde L i t t e r a i r e V (1763), pp.212-16. . ^Bachaumont. Memoires secrets pour s e r v i r a  1'histoire de l a Republique des l e t t r e s en France. (London, 1778) , v.IV, pp. 265-66. 6 7 I b i d . , p.266, 6 8 For an in t e r e s t i n g discussion on health and hygienic practices see William Coleman, "Health and Hygiene i n the Encyclopedic: A Medical Doctrine for the Bourgeoisie," Journal of the History of Medicine and A l l i e d Sciences. XXIX (1974), pp.399-421. 69 For a f u l l e r discussion on the extent of medical practice i n eighteenth-century France, see J.P. Goubert, "The Extent of Medical Practice i n France Around 1780," Journal of S o c i a l History 10 (1977), pp.410-27; Idem, Malades et Medecins, pp. 78-95; J . Meyer, "Le per-sonnel medical en Bretagne a l a f i n du XVIII e s i e c l e , " pp.171-225, i n Desaive et a l . , Medecins, climat, et e p i -demies a l a f i n du XVII1^ s i e c l e (Paris, 1972); T. Gelfand, "Medical Professionals and Charlatans. The Comite de Salubrite enquite of 1790-91," H i s t o i r e S o c i a l e - S o c i a l  History (1978), pp.62-97; Robert H e l l e r , 'Priest-Doctors' as a r u r a l health service i n the age of the Enlightenment," Medical History (1976) , pp.361-65; and F. Lebrun, Les  Hommes et l a mort en Anjou au 17 e et 18 e s i e c l e s (Paris, 1971) , pp.199-235 . 7 0See Meyer, pp.171-192; Goubert, "The Extent of Medical Practice,"pp.411-416; Idem, Malades et Medecins, pp.63-78; Gelfand, p.66; Hannaway, pp.258, 261; and Pierre Lunel, "Pouvoir r o y a l et sante publique a l a v e i l l e de l a Revolution: L'exemple du Roussillon," Annales du Midi 86, (1974) , pp.345-80 . 124. 71 See for example,, the i n t e r e s t i n g study by P. Loupes, "L'Assistance p a r o i s s i a l e aux pauvre.s malades dans l e diocese de Bordeaux au dix-huitieme s i e c l e , " Ann a les du Midi 84 (1972),. pp.37-61; see also H e l l e r , pp. 362-65. 72 A.D. Cher, c 146 document 139, observation by A l l e e , the p r i e s t of Murlin. Cited i n Goubert, "The Extent of Medical Practice," p.416. 7 3 H e l l e r , p.364 . 74 On t h i s topic, see Peter, pp.81-124; Hannaway, pp.257-73; Meyer, "L'enqiiete de 1'Academie de medecine sur les ^pidemies 1774-1794," Etude spuria les no. 34, 1969, pp. 7-69; Goubert, Malades et MeVdecins, pp. 178-181; and Lebrun, pp.294-299. 75 This i n t e r p r e t a t i o n has been revised i n the recent study by Goubert, "The Extent of Medical Practice," p.413. Goubert has stated: " I t remains that the "medical desert" of the countryside i s not i n fact a void. This' b e l i e f arises from the "enlightened" judgement of ^'a.1 minority of the medical community, who perceive a desert wherever the most learned medicine i s absent. I t also stems and one must keep t h i s i n mind, from the i n s t i t u t i o n a l organization of medicine and surgery on the eve of the revolution, an organization which condemns the countryside to the ranks of the l e a s t educated, the l e a s t scholarly elements of the medical community, which i s not necessarily the most inept!" On t h i s same topic, see Gelfand, pp.62-97; and Goubert," L'Art de guerir. Mtdecine savante et mtdecine populaire dans l a France de 1790," Annales  E .S.C . XXXII (1977) , pp.908-26. 7 6 Montyon, vol.2, p. 145. 7 7 I b i d . , p.144 . 7 8 I b i d . , pp.144-45 . 7 9 I b i d . , p.145 . 8 0 I b i d . , pp.146-47. 81 La Condamine, "Suite de 1'histoire de 1'inocula-t i o n de l a petite verole, depuis 175 8 jusqu'en 1765. Troisieme Memoire," H i s t o i r e de 1'Academie Royale des  Sciences (Paris, 1765), pp.513-14. 125 . 82 Ibid., pp.515, 517-18. La Condamine wrote: "Non-seulement i l est probable, mais i l est demontre par les l o i x de l a p r o b a b i l i t y q u e sur un cer t a i n nombre d'inocules, sur-tout dans un temps d'epidemie, quelques-uns doivent avoir d e j a c o n t r a c t e l ' i n f e c t i o n du virus par l a contagion naturelle avant de subir 1'operation," On the other hand, he noted: "On avoit repandu le b r u i t que cette pratique entretenoit l'dpidemie." 8 3 From Nouvelles Observations (Paris, 1766) . Cited i n De Foygny, T r a i t e pratique de 1'inoculation. Extract i n Journal Encycjopedique IX (176 8), pp.75-76. 84 La Condamine, "Suite," p.517. 8 5 I b i d . , p.518. 86 ^ "Lettre de M. de l a Condamine a. M. Le Docteur Maty sur l ' e t a t present de 1 1 inoculation en France," L'Annee L i t t e r a i r e , VII (1764), pp.263-64. 8 7 D'Alembert,"Correspondance," Oeuvres completes, V, (Paris 1821-22; reprint ed., Geneva: Skatline, 1967), p.110. 88 V o l t a i r e , Oeuvres completes, XXIV Moland Ed., (Paris, 1879) , p.467 . 8 9 " L e t t r e de M. de l a Condamine," VII, p.263. For a detailed account of the controversy see P. Delaunay, Le Monde medical (Paris, 1906), pp.285-90. 9 1 I b i d . , p.285 . 9 2 L'Epine, "Avis sur 1'inoculation de l a p e t i t e verole," Extract i n Journal de Trevoux LXIV (1764), p.503. 9 3 " L e t t r e de M. de l a Condamine, VII, p.264 . La Condamine expressed his disappointment about the • decision and wrote:'"J'avoue que je ne concois pas bien, qu'on puisse tout a l a f o i s soutenir qu'une pratique est u t i l e , s a l u t a i r e , avantageuse au bien de l ' E t a t , & conclure seulement a l a tolerance de c e l l e pratique. S i 1'Inoculation est un mai, e l l e ne doi t pas etre meme toieree; s i c'est un bien, ce n'est pas assez de l a permettre,-elle d o i t etre autoriste, encouragee protegee. J'en appelle a l a conscience de ceux qui se sont born§s a conclure a l a tolerance, par l a crainte, mal fondte a mon avis, de ne pouvoir obtenir r i e n de plus." 94 See Delaunay, pp.285-90. 95 G.J.de l'Epine. Rapport sur l e f a i t de  1'inoculation de l a p e t i t e verole l u en presence de l a  Faculty de Medecine de P a r i s , & imprime" par son ordre  pour etre communique a. tous les Docteurs, avant qu'elle  donne, sur cette question,- l j ' avis que le Parlement l u i  a demande par son arret du 8 j u i n 1763. Cited i n L'Annee  L i t t t r a i r e . ' . I I , (176 5) , pp.110-11. 9 6 I b i d . , p.110. 97 Ibid., p . l l l . 9 8 L a Condamine, "Suite," pp.519-20. 9 9 "Lettre de M. le President de l a Moignon a M. Fr£ron," L'Annte L i t t t r a i r e , II (1765) , p .112". 1 0 0 I b i d . , p.113. "''^1Antoine P e t i t , Premier & Second Rapport en  faveur de 1' inoculation. Extract i n L'Annte L i t t e r a i r e V (1766, pp.169-98. P e t i t , pp.171-72, pointed out: "Le but dans cet e c r i t a &t& de se f a i r e entendre de tout l e monde; sur les matieres de science, on s'en rapporte volontiers au'jugement des Scavans on les c r o i t sur  parole"'. In t h i s case the nature of the problem was funda-mentally d i f f e r e n t and to formulate a judgement?"II faut done se borner a i n s t u i r e , a persuader, i l faut e c r i r e avec c l a r t e , " to d i f f u s e information to the French public i n general. 1 0 2 I b i d . , pp.179-80.. 1 0 3 I b i d . , p.185. 104 Bachaumont, v . I l l , p.68. Delaunay, p.286. J..J. Gardane, Observations  sur l a meilleure maniere d'inoculer l a p e t i t e verole. Extract i n L'Annee L i t t t r a i r e VI, (1767), p.249 , stated 127. "mais comme on inoculeV dans l e Banlieue de l a Capitale, & peut-etre dans l a Capitale meme, quoiqu'en secret, & q u ' i l peut a r r i v e r que le jugement de l a Faculte 1'authorise ." 1 0 6 " L e t t r e de M. de l a Condamine, VII, p.267. 10 7 "Eloge," p.114. Condorcet summed up his contribution to the controversy over inoculation as follows: "Si par I ' e f f e t d'un usage general de 1'inoculation le fleau t e r r i b l e de l a p e t i t e verole d i s p a r a i t un jour de l a t e r r e . . . l e nom de M. de l a Condamine sera prononce avec attendrissement par quiconque attachera quelque pr i x a l a vie ou sentira c e l u i de l a beaute." " E x t r a i t d'une l e t t r e du 25 A v r i l 1769." Journal Encyclopigdique-VI, (1769), pp.288-89 . F. Lebrun, pp.286-87 . 1 0 9 " E x t r a i t , " p.290. 1" L 0"Rapport des inoculations f a i t e s dans l a Famille Royale au chateau de Marly, l u a 1'Academie Royale des Sciences l e 20 j u i l l e t 1774, par M. Lassone," Mercure de France VII, (1774), p.127, wrote: L'heureuse inoculation du Roi, de Monsieur, de Monseigneur, le Comte d'Artois & de Madame l a Comtesse d'Artois, est une epoque trop memorable dans 1'histoire des f a i t s r e l a t i f s aux sciences u t i l e s . " 1 "'""'"According to the recent l i t e r a t u r e , the medical corps during the late eighteenth century only came to the r u r a l masses victimized by disease such as smallpox when there was a severe epidemic; the rest of the time they were not under the p r o v i n c i a l doctor or surgeon's care. For a discussion on t h i s topic see F. Lebrun, pp.287-88; Goubert, Malades et Medecins, pp.323-28; Peter, pp.113-115; Hannaway, pp.260-62; and Barblan, p.202. 112 "Epidemic constitutions" was the medical theory formulated by the English doctor, Thomas Sydenham, which implied that variations i n outbreak of smallpox or any other epidemic were dependent on the cl i m a t i c con-diti o n s or changes i n the atmosphere. For a discussion on t h i s topic see Peter, pp.100-107; Foucault, pp.178-96; Le Roy Ladurie & Desaive, "Etude par ordinateur des donn^es m§t4orolgiques constitutes par les correspondants de l a Society Royale de Medecine (1766-1792)," i n Desaive et a l . , pp.21-61; and Hannaway. pp.263-73. 113 On t h i s topic see, for example, Barblan, passim. 128. CONCLUSION This study has attempted to revise the conventional medical interpretation of the history of smallpox ino-culation i n early and mid-eighteenth century France. I t has examined and analyzed the nature of the controversy and the reactions of the learned community.and medical profession i n French society to the medical, s o c i a l and r e l i g i o u s aspects of the problem. The approach has stressed those aspects of the s o c i a l history of medical ideas and practices and of the s o c i a l history of con-temporary thought which seems to make sense of the im-portant discussions over inoculation. In the early period, the r e l a t i v e lag of inoculation in France as compared to England was r e f l e c t e d i n the responses of contemporaries toward the widespread be-l i e f that inoculation spread the natural form of smallpox to vulnerable members of the population. This, i n turn, increased the fears of the vulnerable population which provoked great h o s t i l i t y , p a r t i c u l a r l y within the medical profession, toward the pr a c t i c e . Although "enlightened" medical men campaigned on behalf of inoculation, i t appears that t h i s fear was a major reason for rejecting inoculation as an innovative technique designed to save l i v e s . I t also seems that the conventional medical wisdom paid l i t t l e attention to the fact that poor health and hygiene probably increased the mortality of smallpox during the period under discussion. By the mid-eighteenth century, however, i t was becoming increasingly clear to many learned men that dramatic s t r u c t u r a l changes were needed i n s o c i a l organization i n order to deal e f f e c t i v e l y with community problems related to public health and hygiene. This position was held together and reinforced by contemporary views on medical advancement. Since innovation i n techni-que and medical knowledge were required as indispensable for the improvements i n l i v i n g conditions, smallpox inoculation was considered to be capable, through i n -creased knowledge and improved techniques, of contributing greatly to French society and the state. In t h i s respect, the support for inoculation was c l o s e l y associated with the r e l a t i o n s h i p between p o l i t i c a l economy and public health which stressed on the one hand, the needs of the state as an active force mobilizing human and s o c i a l resources as a means of wealth and power. Ch a r a c t e r i s t i c of the period, on the other hand, was a growing concern by "enlightened" governmental authorities and medical men to control the disease, i n order to insure a healthy population, by i s o l a t i o n and quarantine measures rather than by deliberate exposure of smallpox to unprotected people i n the community. 130-I t was also recognized that the implementation of new medical practices could be made most e f f e c t i v e through an informed public opinion. In t h i s connection, the attempt i n demonstrate mathematically p r o b a b i l i s t i c formulations to s o c i a l and medical a f f a i r s was indeed very ambitious and of h i s t o r i c a l s i g n i f i c a n c e . Since the u n i v e r s a l i t y of smallpox i n the eighteenth century operated on the assumption that the disease was contracted by almost, everyone, the p r o b a b i l i s t i c formulations of death from smallpox and the comparative mortality rates of inoculated and natural smallpox cases were fundamental to the conception of decision-making as the c o l l e c t i v e search for the s o c i a l e f f i c a c y of the medical p r a c t i c e . Despite the e f f o r t s of the "enlightened" segments of the medical profession and learned community to f a m i l i a r i z e the population with the benefits of inoculation, and the highly successful innovation of technique, the practice of popular inoculation did not occur at any point i n the eighteenth century. The li m i t e d extent of the practice was related to two features. F i r s t l y , the fear that p a r t i a l inoculations of only some members of the community would spread the natural form of the disease to the rest; and secondly, the r e l a t i v e l y high price of inoculation and the reluctance of medical personnel to spread inoculation to the suffering masses. The controversy over inoculation was t y p i c a l of the many c o n f l i c t s between tr a d i t i o n a l i s m and the secula r l y -oriented ideas of the Enlightenment. In thi s respect, i t 131. was the issue of whether or not the practice of inoculation was.an e f f e c t i v e prophylaxsis against small-pox or morally wrong which represented one of the con-f l i c t s between the philosophies and the Church. The Church made a case for the r e l a t i o n between soul and God, the b e l i e f that i t was a si n to de l i b e r a t e l y and needlessly cause i l l n e s s , and the fact that i l l n e s s i t -s e l f was part of providence seen i n the contemporary eye as a punishment for sins committed to insure the s p i r i t u a l salvation of the i n d i v i d u a l . On the other hand, the "enlightened" view held that the "public good" was the desired goal of the s o c i a l endeavor, that i n order to achieve t h i s i t was necessary to think i n terms of the s o c i a l order, make general laws, begin public health and hygienic measures and i n s t i t u t e general practices for the good of French society as a whole, though they might . r offend the prejudices of certa i n i n d i v i d u a l s or groups. If medicine offered the means to transform the s o c i a l world, i t also suggested the model of the s o c i a l organization to be implemented. The controversy over inoculation against smallpox throughout the eighteenth century can be seen as a two-fold program: f i r s t l y , i t represented the learned community's campaign against an infe c t i o u s disease; and secondly, the practice of ino-culation represented one of the f i r s t attempts i n France to spread the habit of health and hygiene which, i n turn, slowly deflated the power of custom and t r a d i t i o n i n the realm of human experience. 132 . SELECTED BIBLIOGRAPHY I. PRIMARY SOURCES: Alembert, J.L.DV. "Reflexions sur 1 1 inoculation." Oeuvres completes. I. Paris, 1821-22; re p r i n t ed., Geneva: Skatline, 1967):. 467-514 . "Correspondance L'" Oeuvres completes. V. P a r i s , 1821-22; r e p r i n t ed., Geneva: Skatline, 1967: 110-115. "Avis sur 1'inoculation de l a pe t i t e verole." L'Annee  L i t t e r a i r e VI (1763): 307-311. Bachaumont. Louis P e t i t de . Memoire secrets pour _s.ery_ir  a. 1'histoire de l a Republique des l e t t r e s en^France. Vols. I l l and IV. London: J . Adamson, 1778. Be r n o u l l i , D. "Essai d'une nouvelle analyse de l a mortalite causee par l a pe t i t e verole et des advantages de 1'inoculation pour l a prevenir." H i s t o i r e de 1'Academie Royale des Sciences. Pt. I I . Paris, 1760: 1-45. . "Reflexions sur les avantages de 1'inoculation." Mercure de France Vol. I IV (1760): 136-150. Cantwell, Andrew. Dissertation sur 1'inoculation pour  se r v i r de reponse a c e l l e de ,M. de l a Condamine de  l'Academie Royale des Sciences sur l e meme sujet. Extract i n L'Annee L i t t e r a i r e V (1755): 261-288. C o l l e , Charles: Journal et memoires sur les hommes les ouvraqes dramatiques e t les 'evenements les plus  memorables du regne de Louis XV (1748-1772). I I . Paris, 1868. Condorcet. "Eloge de M. de l a Condamine." H i s t o i r e de  l'Academie Royale des Sciences. Paris, 1774: 85-121. DeBaux. P a r a i l e l e de l a pe t i t e verole naturelle avec  1 ' a r t i f i c i e l l e ou inoculee. Extract i n Mercure de France Vol. I ..VII (1760): 171-175 . De Foigny, Gandoger. T r a i t e pratique de 1'inoculation. Extract i n Journal Encyclopedigue IX (1768): 68-77 133. Delacoste, Jean. "A Letter from Delacoste to S i r Hans Sloane Barr. C o l l . Med. Lon., concerning the Inoculation of the Small-Pox." Philosophica1  Transactions XXXII (1723): 314-18. ________ Lettre sur 1' inoculation de l a p e t i t e verole comme e l l e se pratique en Turquie et en Angleterre. Extract i n Journal de Trevoux XXIV (1724): 1073-1 0 9 0 . Diderot. "De 1'inoculation." Oeuvres completes. IX. Edited by J . Assezat & M. Tourneux. Paris: Garnier Freres, 1857: 207-212. Duboueix. "Histoire de 1 *etablissement & des succ^s de 1'inoculation dans l a v i l l e de Nantes." Journal  Ericyclope'dlque III (1774): 491-510. "E x t r a i t d'une l e t t r e du 25 A v r i l 1769, Remerciment a. M. G a t t i . " - Journal Encyclopedique VI (1769) : 287-90. Fontenelle. "Eloge de Chirac." Oeuvres. VII. P a r i s , 1792. Gardane, J . J . Observations sur l a meilleur maniere d'inoculer l a p e t i t e verole. Extract i n L'Annee L i t t e r a i r e VI (1767): 248-59. G a t t i , Angelo. , New Observations on Inoculation. London, 1768. Cited i n Charles Crei.ghton. The History  of Epidemics i n Great B r i t a i n . 2nd Ed. London: Cass, 1965: 469-70. Grimm, Diderot et a l . Correspondance, l i t t e r a i r e philosophique et c r i t i q u e . Vols. I l l and VII. Paris: Garnier Freres, T 8 7 7 . Hecquet, P h i l l i p e . Observations sur l a saignee du pied, et sur l a purgation au commencement de l a p e t i t e  verole, des fifevres malignes & des grandes maladies. Preuves de decadence dans l a pratique de medecine, confirmees par de justes raisons de doute contre  1'inoculation. P a r i s , 1724. Hosty, Ambroise. "Rapport de M. Hosty, Medecin, au sujet de 1'inoculation." L'Annee L i t t e r a i r e IV (1755): 242-58. Kennedy, Peter. An Essay on External Remedies. London, 1715. La Condamine, Charles M. de. "Observations Mathematiques et Physiques. Faites dans un voyage de Levant en 1732." H i s t o i r e de 1' Academie Royale des Sciences. 134 . Paris, 1732,: 295-322 . . "Memoire sur 1'inoculation de la petite verble ." Histoire de T'Acadgmie Royale des  Sciences. Paris, 1754: 615-70. "Second Mdmoire sur 1'inoculation, de la petite verole contenant la suite de 1'histoire de cette; methode & de ses progres, de 1754 £ 1758," Histoire de 1'Academie Royale des Sciences. Paris, 1758: 439-82. "Suite de l'histoire de 1 * inoculation de l a petite verole. depuis 1758 jusqu'en 1765. Troisieme. Memoire." Histoire de 1'Academie Royale  des Sciences. Paris, 1765: 505-32. ________ "Reponse de M. de la Condamine au defi de M. Gaullard." Mercure de France IX (1759) : 189-96. "Lettre de M. de la Condamine a M. Daniel Bernoulli." Mercure de France Vol.1 IV (1760): 165-89 . "Lettre de M. de la Condamine a M . le Docteur Maty." L'Annee Litteraire VI (1764): 285-88. _______ "Lettre de M. de l a Condamine a M. le Docteur Maty sur 1'etat present de 1'inoculation en France." L'Annee Litteraire VII: (1764) : 255-68. Lassone. "Rapport des inoculations faites dans la famille royale au chateau de Marly." Mercure de  France VIII (1774): 126-29. LeCamus. "Maison d'inoculation." L'Annee Litteraire VIII (1770): 206-211. L'Epine de. "Avis sur 1'inoculation de l a petite verole." Extract in Journal de Trevoux LXIV (1764): 488-511. Rapport sur le f a i t del'inoculation de la petite verole, l u en presence de la Faculte de  Medecine de Paris, & imprime par son ordre, pour  etre communique a tous les Docteurs, avant qu' elle donne, sur cette question, l'avis que le Parlement l u i a demande* par son arret du 8 juin 176 3. Cited in "Lettre de M. le. President de la Moignon, a M. Freron." L'Annee'Littdraire"II (1765): 110-113. j , "Lettre de M. le President de la Moignon a M. Freron." L'Annee Litteraire II (1765): 110-113. "Lettre sur 1' inoculation. " '. L'Annee L i t t e r a i r e VI (1765): 325-38. "L 1Inoculation de l a pe t i t e verole deferde a l ' E g l i s e et aux Magistrats." Journal de Trdvoux LVII (1757) : 117-38. Maitland, Charles. An Account of Inoculating the  Smallpox. London, 172 3. "Memoire sur 1'inoculation de l a pe t i t e verole." Extract i n Journal des Savants (July, 1754): 509-510. "Memoire sur 1'inoculation de l a p e t i t e verole." Extract i n Journal de Trevoux LIV (1754): 2347-57. "Memoire sur 1'inoculation de l a p e t i t e verole." Extract i n L'Annee L i t t e r a i r e VI (1754): 192-209. "Methode de 1'Inoculation." L'Annee L i t t e r a i r e VI (1754): 337-43. Montyon, Antoine. Recherches et considerations sur l a population de l a France. 2 Vols. P a r i s : Moutard, 1778. Nettleton, Thomas. "A Letter to Dr. Jurin . " Philosophical Transactions XXXI (1720-22): 35-48. "Origine, progr^s, etat de l'Hopital de l a p e t i t e verole naturelle et inocuiee, depuis q u ' i l a ete fonde a Londres le 26 septembre 1746, jusqu'en mars 1763." L ' Annee L i t t e r a i r e V (1763): 212-16. P e t i t , Antoine. Premier & Second Rapport en faveur de  1'inoculation. Extract i n L'Annee L i t t e r a i r e V (1766): 169-98. P y l a r i n i , Jacob. "Nova et tuta excitandi per transplatationem methodus; nuper inventa et i n usum tra c t a . " Philosophical Transactions XXXIX (Jan.- Mar. 1716): 393-99 . P a r t i c u l a r l y , p.393. Translated by W.J. Dusing. "Rapport des quartres medecins qui ont v i s i t e l'enfant inocuie, soupconne d'avoir eu une seconde p e t i t e verole." Mercure de France I (1759) : 154-70. "Recherches sur quelques points d'histoire de l a medecine." Journal de Trevoux LXV (1765): 239-68. 1 3 6 . Robert. Recherches sur l a nature et inoculation de l a p e t i t e .verole.. Extract, i n L'Annee L i t t e r a i r e VI (1763): 203-12. Timoni, Emmanueli. "An Account or History of the Procuring the Small Pox by I n c i s i o n ; or Inocula-t i o n . As i t has for Some Time Been Practised at Constantinople." Philosbphical Transactions XXIX (April-June 1714): 72-82. Ti s s o t , Samuel Andre D. Avis au peuple sur sa dante. Lausanne, 1787. Tronchin, Theodore. A r t i c l e on "Inoculation." In Diderot and D'Alembert, Encyclopedie, ou  dictionnaire raisonne des sciences, des arts, des metiers. VIII. P a r i s , 1765: 755-68. V o l t a i r e . "Sur 1'insertion de l a p e t i t e verole." In Lettres Philosophiques. I-... Edited by Gustave Lanson. New e d i t i o n by Andre Rousseau. Pa r i s : Didier, 1964: 130-51. Oeuvres completes. XXIV. Edited by Louis Moland. Paris Garnier Freres, 1879. Wagstaffe, W. A Letter to Dr. Friend Shewing the  Danger and Uncertainty of Inoculating the Smallpox. London, 1722. SELECTED B I B L I O G R A P H Y I I . SECONDARY SOURCES: a) Books AckerknechtV ; Erwin H. Medicine at the Paris Hospital 1794-184 8. Baltimore: The Johns Hopkins University-Press, 1967. Aries, "'Philippe. Western Attitudes toward Death from  the Middle Ages to the Present. Translated by P. Ranum. Baltimore: The Johns Hopkins University Press, 1974. Baker, Keith. Condorcet: From Natural Philosophy to Soci a l Mathematics. Chicago: University of Chicago Press, 1975. Bariety, M. and Coury, C. H i s t o i r e de l a me" de cine. Paris: Fayard, 1963. Bourde, A.J. Agroriomie et agronomes en France au 18 e s i e c l e . V o l . 3 Par i s : S.E.V.P.E.N., 1967. B o u t e i l l e r , M. Medecine populaire d'hier et d'aujourd' hui. P a r i s : Maisonneuve and Larose, 1966. Coury, C. L'Enseignement de l a medecine en France. Par i s : Expansion S c i e n t i f i q u e Francaise, 1968. Delaunay, Paul. Le Monde medical p a r i s i e n au XVIII e  s i e c l e . P a r i s : J. Rousset, 1906. Desaive, J.P. et a l . Mtdecins, climat, e t epidemies a  l a f i n du XVIII e s i e c l e . P a r i s : Mouton, 19 72. Dupaquier, Jacques. Introduction a l a demographie  historique . Par i s : S ,'E .V.P .E .N., 1974. Foucault, Michel. The B i r t h of the C l i n i c . Translated by A.M. Sheridan Smith. New York: Pantheon Books, 1973. Furet, Francois et a l . Livre et S o c i e t e . I. Paris: Mouton, 1965. Genovese-Fox, E. The Origins of Physloeracy. Ithaca: Cornell University. 138. Goubert, J.P. Malades et Medecins en Bretagne  1770-179 0. Paris: Klincksieck, 1974. Hanh, Roger. The Anatomy of a S c i e n t i f i c I n s t i t u t i o n : The Paris Academy of Sciences 1666-180 3. Berkeley: University of C a l i f o r n i a Press, 1971. Hirschman, A. The Passions and the Interests. Princeton: Princeton University Press, 1977. Hufton, Olwen H. The Poor of Eighteenth-Century France 1750-1789^ Oxford:/ Clarendon Press, 1974 . King, Lester. The Medical World of the 18th Century. Chicago: University of Chicago Press, 1958. ' . The Philosophy of Medicine. Cambridge: Harvard University Press, 1978. Labrousse, Ernest et a l . H i s t o i r e economique et s o c i a l e  de l a France. V o l . I I . Paris: Mouton, 1970. Lebruh, Francois . Les Hommes et l a mort en Anjou au  17 e et 186 s i e c l e s . P a r i s : Mouton, 1971. Lyons, Henry S i r . The Royal Society 1660-1940. A History of i t s Administration under i t s Charters. Cambridge: Cambridge University Press, 1944. McKeown, Thomas. The Modern Rise of Population. London, Arnold, 1976. Meek, Ronald. The Economics of Physiocracy. Cambridge: Cambridge University Press. • • - •; . S o c i a l Science and the Ignoble Savage. Cambridge: Cambridge University Press, 1976. Meyer,: Jean. La noblesse Bretonne au 18 s i e c l e . Paris: S.E .V.P.E.N. , 1966. M i l l e r , Genevieve. The Adoption of Inoculation for  Smallpox i n England and France. Philadelphia: University of Pennsylvania Press, 1957. Morineau, Michel. Les Faux-Semblants d'un demarrage economique: agriculture et demographique en France  au 186 s i e c l e de l'anCien regime. Paris: A. C o l i n 1971. "• O'Keefe, C y r i l B. Contemporary Reactions to the Enlightenment 1728-1762. Geneva: Skatline, 1974. Razzell, P.E. The Conquest of Smallpox. Sussex: Caliban Press, 1977. 139. Sprengel, Kurt. H i s t o i r e de l a medecine, depuis son  origine jusqu' au dix-neuvieme s i e c l e . Traduite de 1'aalemand sur l a secoride. E d i t i o n , par A.J.L. Jourdan. VI. Paris, 1815: 33-80. Vovelle, M. Pi^te" baroque et d e c h r i s t i a n i z a t i o n en Provence au XVIIie s i e c l e . P a r i s : Gallimard, 1973. . Mourir autrefois: Attitudes c o l l e c t i v e s devant l a mort au XVII® et XVIII e sifecles. Paris: Gallimard, 1974. Wilson, Arthur M. Diderot. New York: Oxford University Press, 1972. 140. I I I . SECONDARY SOURCES: b) A r t i c l e s Barblan, Marc. "La Variole dans le Departement du Leman en 1811 (d' apres les r e g i s t r e s de l a conscription napoleonienne)." Gesnerus 31 (1974): 193-220. Behar, L. "Des Tables de Mortality aux XVII e et XVIII e s i e c l e s : H i s t o i r e - S i g n i f i c a t i o n . " Annales De Demographies Historique (1976): 175-200. Blayo, Y. and Henry Louis. "Donnees Demographiques sur l a Bretagne et l'Anjou." Annales De  Demographie Historique (1976): 91-171. Coleman, William. "Health and Hygiene i n the Encyclo-pedic : A Medical Doctrine for the Bourgeoisie." Journal Of the History of Medicine and A l l i e d  Sciences XXIX (1974): 399-421. Conlon, P i e r r e . "La Condamine the i n q u i s i t i v e . " Studies On V o l t a i r e and the 18th Century LV (1967) : 361-94. Dupaquier et a l . " V i l l e s et V i l l a g e s de 1'Ancienne France." Annales De Demographie Historique (1968) : 10-141. Everseley, D.E.C. "Epidemiology as S o c i a l History." Forward to Charles Creighton. A History of  Epidemics i n Great B r i t a i n . 2nd E d i t i o n . ./< London: Cass, 1965: 3-39. F i g l i o , K a r l . "The Historiography of S c i e n t i f i c Medicine: An I n v i t a t i o n to the Human Sciences." Comparative Studies i n Society and History XIX (1977): 262-86. Forrest, Alan. "La Revolution et les Hopitaux •'dans le departement de l a Gironde," Annales du Midi 86 (1974): 381-402. Gelfand, T. "Medical Professionals and Charlatans. The Comite de Salubrite enquete of 1790-91." H i s t o i r e Sociale-Social History (1978): 62-97. Goubert, J.P. "Le phenomene epidemique en Bretagne a l a f i n du XVIIie s i e c l e (1770-1787)." In Desaive et a l . M6decins, climat, et epidemies  a l a f i n du XVIIie sifecle. P a r i s : Mouton. 1972: 225-50. "The Extent of Medical France i n France 141. Around 1780." Journal of S o c i a l History 10 (1977): 410-27. • . "L'Art de guerir. Medecine savante et medecine populaire dans l a France de 1790." Annales E.S.C. XXXII (1977): 908-26. Hannaway, Caroline. "The Societe Royale de Medecine and Epidemics i n the Ancien Regime." B u i l e t i n  of the History of Medicine XLVI (1972): 257-73. Heller, Robert. "Priest-Doctors" as a r u r a l health service i n the age of the Enlightenment." Medical History (1976): 361-83. Jeorger, Muriel. "La structure h o s p i t a l i e r e de l a France sous 1'Ancien Regime." .Annales E.S.C. XXXII (1977): 1025-51. Jewson, N.D. "The Disappearance of the Sick-Man from Medical Cosmology. 1770-1870." Sociology X (1976): 221-44. King, Lester. "Medical Theory and Practice at the Beginning of the 18th Century." B u l l e t i n of the  History of Medicine XLVI (1972): 1-15. Ladurie, Le Roy Emmanuel and Desaive, J.P. "Etude par ordinateur des donnees meteorologiques constitutes par les correspondants de la" S o c i e t e Royale de Medecine (1776-179 2)." In Desaive et a l . Medecins, climat, et epidemies a l a f i n du  XVIIie s i e c l e . P a r i s : Mouton, 1972: 21-135 ________ and Goy, J. "Presentation." In Les Fluctuations du produit de l a dime. P a r i s : Mouton, 1982. La Harpe, Jacqueline de. "Le Journal des Savants et l'Angleterre 1702-1789." University of C a l i f o r n i a  Publications i n Modern Philology XX no.6 (1941): 289-520. Lebrun, F. "Les Epidemies en Haute-Bretagne a l a f i n de 1'Ancien Regime (1770-17 89) Presentation d'une enquete c o l l e c t i v e . " .'Annales De Demographie  Historique (1977): 181-206. Le Fann, "The Lost Half Century i n English Medicine." B u l l e t i n of the History Of Medicine XLVI (1972) : 319-49. 142. Loupes, P. "L'Assistance paroissale aux pauvres malades dans les diocese de Bordeaux au dix-huitieme s i e c l e . " Annales du Midi 84 (1972): 37-61. Lunel, P i e r r e . "Pouvoir royal et sante publique a l a v e i l l e de l a Revolution: 1 1 exemple du Roussillon." Annales du Midi' 86 (1974): 345-80. Meuvret, Jean. "Les c r i s e s de subsistance et l a demographie de l a France d'Ancien Regime." Etudes d'histoire Economique. Par i s : S.E.V.P.E.N., 1971: 271-78. Meyer, Jean. "L'enquete de l'Academie de Medecine sur les epidemies 1774-1794." Etudes Rurales no.34 (1969) : 7-69 . . "Le personnel medical en Bretagne a l a f i n du XVIII e s i e c l e . " In Desaive et a l . Medecins  climat, et epidemies a l a f i n du XVIII e s i e c l e . P a r i s : Mouton, 1972: 171-225. McKeown, Thomas, and Brown, R.G. "Medical Evidence Related to English Population Changes i n the 18th Century." In Population i n History. Edited by D.E.C. Everseley and D.V. Glass. Chicago: Aldine, 1965: 285-307. . "Medical Issues i n H i s t o r i c a l Demography." In Modern Methods i n the History of Medicine. Edited by Edwin Clarke. London: Athlone Press, 1971: 57-74. f , and Record, R.G. "An Interpretation of the Modern Rise of Population i n Europe." Population Studies 26 (1972) : 345-82. Nogaret, Chaussinand-Guy. "Nobles medecins et medecins de cour au XVIIie s i e c l e . " Annales E,S,C. XXXII (1977): 851-57. "Nosographie." In Dictionnaire des Sciences Medicales 36 Paris: Panckoucke, 1819: 206-65. Morineau, Michel. "Histoire sans f r o n t i e r e : p r i x et revolution agricole." Annales E.S.C. (1969) : 403-23. Perkin, Harold. "Social History i n B r i t a i n . " Journal of S o c i a l History 10 (1976): 129-43. 143 . Perrenoud, A l f r e d . "Deux cents ans de Variole a Geneve. Contribution a 1'histoire cyclique des maladies." In International Colloquium i n  B e r l i n (West) , "(1978) : 3 0 - 3 3 . Perrot, Michelle. "The Strengths and Weaknesses of French S o c i a l History 1." Journal of S o c i a l History 10 (1976): 166-77. Peter, J.P. "Les mots et les objets de l a maladie. Remarques sur les tpid£mies et l a medecine dans l a society francaise de l a f i n du XVIII e s i e c l e . " Revue historique 246 (1971) : 13-38. "Disease and the Sick at the End of the Eighteenth Century." Translated by E. Forster. In Biology of Man i n History. Edited by R. Forster and 0. Ranum. Baltimore: The Johns Hopkins University Press, 1975: 81-124. Razzell, P .E . "Population Change i n 18th century England." Economic History Review .18 (1965) : 312-32. Shapiro, Gilberts "Prospects For A S c i e n t i f i c S o c i a l History: 1976." Journal for S o c i a l History 10 (1976): 196-204. Sigsworth, E.M. "Gateways to Death? Medicine, Hospitals and Mortality 1700-1850." In Science and Society Edited by P. Mathias. London: Cambridge University Press, 1972: 97-110. Turpsinen, Oiva. "Mortality from Smallpox, Measles and Whooping Cough In Finland 1751-186 5." In International Colloquium i n B e r l i n (West),(19 78): 20-23. "Variole." In Dictionnaire des Sciences Medicales 57 Paris: Panckoucke, 1821L 33-102. Vovelle, M. "Les attitudes devant l a mort: problemes de methode, approaches et lectures d i f f e r e n t e s . " Annales E.S.C. XXXI (1976): 120-32. Waddington, I. "The Role of the Hospital i n the Develop-ment of Modern Medicine: A S o c i o l o g i c a l Analysis." Sociology 7 (1973): 211-24. Zeldin, Theodore. "Social History and Total History." Journal of S o c i a l History 1 0 ( 1 9 7 6 ) : 2 3 7 - 4 5 . 

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